Acute Appendicitis in Pregnancy and the Developing World

Abstract

Background Acute appendicitis is the commonest nonobstetric surgical emergency during pregnancy. The aim of the study was to compare perioperative outcomes of acute appendicitis in pregnant and nonpregnant patients. Methods A retrospective review of medical records of 56 pregnant patients between 2011 and 2016 who were compared with 164 nonpregnant women of reproductive age who underwent open appendectomy between 2014 and 2016 for acute appendicitis. The patient's demographics and perioperative data were analyzed. Results The median age of pregnant and nonpregnant patients observed was 26 years (range 19–37) and 26 years (range 18–43). There were no significant differences between the groups in negative appendectomy (21.4 and 21.3%, P = 0.52), perforated appendicitis (25 and 23.8%, P = 0.85), postoperative complications (28.6 and 26.8%, P = 0.80), and median length of hospital stay (5 and 4.5 days, P = 0.36). There were 3.6% preterm labour, no maternal mortality, and no fetal loss. In multivariate analysis, WBC >18000/mm3 and long patient time to surgery were independent risk factors for appendicular perforation and postoperative complication (P < 0.05). Conclusion Our results of appendectomy in pregnant patients are comparable with nonpregnant patients. Hence the same perioperative treatment protocol can be followed in pregnant and nonpregnant patients even in resource-poor setting.

Diagnosis, Management and Clinicopathological Features of Acute Appendicitis in Pregnant Women and Its Impact on Fetal Outcomes

“…It was suggested that the inflammatory markers seemed to have a less diagnostic value in pregnant women with suspected appendicitis compared to their healthy pregnant counterparts. Similarly, we did not find a significant difference between the pregnant women with appendicitis versus the non-pregnant women with appendicitis with regard to leucocyte and lymphocyte counts nor with regard to the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte, and CRP values on admission (13,15). Although not statistically significant, the mean CRP level was found to be 3 times higher in the pregnant women with appendicitis than in the negative appendectomy group (11.1 mg/L vs. 32.5 mg/L, p=0.478).…”

“…Appendicitis is the most prevalent cause of non-traumatic emergencies of the digestive tract necessitating surgical treatment in pregnant women, with a prevalence of 0.1-0.2% (6,15). In this study, the appendicitis incidence during pregnancy was 1 in 265 births (0.38%) during the period between 2016 and 2019.…”

“…It has been shown that leukocytosis occurs due to an increased number of neutrophils in blood circulation during pregnancy and that neutrophils begin to increase in the second trimester, then remain constant with the total number ranging between 9 and 15000 (15,17,20). The differential diagnosis of appendicitis in pregnancy includes several inflammatory conditions, all of which are characterized by leukocytosis.…”

Laparoscopic versus open appendectomy in pregnancy: A single center experience

“…In a large population-based study, the negative appendectomy rate is 17.4%. [10] Bhandari et al [11] reported that the negative appendectomy rates are 21.4% and 21.3% (p=0.52) in their pregnant and non-pregnant cohorts, respectively. In our study, we observed the negative appendectomy rate in 4 (7%) patients.…”

Laparostomy during pregnancy: A case report

“…Acute appendicitis is the main indication for surgery during pregnancy. It is estimated that acute appendicitis occurs between 0.06% and 0.28% [ 1 ] in the pregnant woman, 40% of cases taking place on the second trimester [ 2 ]. Although pregnancy is not a risk factor for acute appendicitis, appendix rupture is higher amongst pregnant women [ 2 ].…”