Management and Outcomes of Appendectomy during Pregnancy

Won, Roy P.; Friedlander, Scott; Lee, Steven L.

doi:10.1177/000313481708301018

Cited by 23 publications

(28 citation statements)

References 15 publications

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“…37 In addition, Won et al indicated that despite the fact that pregnant women had higher negative appendectomy rates and a lower possibility of undergoing laparoscopic appendectomy, there was no difference in surgical complications that were not related to pregnancy and, while there was an increase in preterm labour risk during surgery, that risk diminished over time. 38 Furthermore, Walker et al outlined the lack of strong evidence between laparoscopic and open appendectomy during pregnancy, nevertheless a slight increase in fetal loss rates for those who underwent laparoscopic appendectomy was demonstrated. 39 Preterm labour was the only finding in 2 of 11 pregnant women who underwent laparoscopic appendectomy, as Kocael…”

Section: Frountzas Nikolaou Stergios Kontzoglou Toutouzas Pergialiotismentioning

confidence: 99%

Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies

Frountzas

Nikolaou

Stergios

et al. 2019

annals

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Introduction Acute appendicitis is a common and serious situation during pregnancy, because of the increased risk of fetal loss and perforation in the third trimester, as well as a diagnostic difficulty. During recent years laparoscopic approach has been introduced to clinical practice with encouraging results. The purpose of this meta-analysis is to compare the surgical and obstetrical outcomes between laparoscopic and open appendectomy during pregnancy. Materials and methods MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on postoperative outcomes between laparoscopic and open appendectomy during pregnancy. The random effects model (DerSimonian–Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel–Haenszel) model was implemented. Results Twenty-one studies that enrolled 6276 pregnant women are included in the present meta-analysis. Of these women, 1963 underwent laparoscopic appendectomy and 4313 underwent an open appendectomy. Women who underwent laparoscopic appendectomy demonstrated an increase in fetal loss risk, while neonates of women that underwent open appendectomy presented decreased Apgar score at five minutes after birth. All the rest outcomes were similar between the two groups. The time that each study took place seemed to affect the comparison of birth weight and postoperative hospital stay between the two groups. Conclusion Laparoscopic appendectomy seems to be a relatively safe therapeutic option in pregnancy when it is indicated. Thus, it should be implemented in clinical practice, always considering the experience of the surgeon in such procedures. Nevertheless, the need of new studies to enhance this statement remains crucial.

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Section: Frountzas Nikolaou Stergios Kontzoglou Toutouzas Pergialiotismentioning

confidence: 99%

Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies

Frountzas

Nikolaou

Stergios

et al. 2019

annals

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“…[12] According to a recent study evaluating laparoscopy in pregnancy, it has been reported that 50% less laparoscopy is performed in pregnant patients, pregnancy has no effect on perforation rates, but negative appendectomy rate has increased in pregnancy. [13] The mean gestational week of the L/S group was smaller and the postoperative complication rate was lower. It has been claimed that L/S appendectomy does not affect obstetric outcomes in pregnancy.…”

Section: Discussionmentioning

confidence: 87%

Acute appendicitis in pregnancy: 50 case series, maternal and neonatal outcomes

Okçu

Cesur

İrkörücü

2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:During pregnancy, the most common indication for non-obstetric surgery in acute abdomen is appendicitis. In pregnancy, appendicitis may be confused with pregnancy-related pathologies and may cause a delay in diagnosis or unnecessary surgery. The present study aims to evaluate the maternal and neonatal outcomes of patients undergoing appendectomy during pregnancy. METHODS:This study was designed retrospectively between 2011-2017. Appendicitis detection rates, admission and laboratory features, operation results and obstetric results were evaluated in pregnant women who underwent surgery for a preliminary diagnosis of acute appendicitis. RESULTS:The findings showed that 2593 patients underwent an appendectomy, 1154 of them were women and 50 of them were pregnant. Negative laparotomy was detected in 12 (16%) patients. Six (12%) of these 50 patients had a laparoscopic appendectomy and 44 (88%) had an appendectomy with laparotomy. The mean time to operation after admission to hospital was 10.5±11 hours. No maternal mortality was observed. Preterm labor occurred in four (8%) patients. Two patients (4%) were in the second trimester and two patients (4%) were in the third trimester. Two (4%) newborns born in the second trimester died postpartum. One of these newborns had multiple anomalies. Appendectomy was not characterized by an increased risk of perinatal mortality. CONCLUSION: Delay in the diagnosis and surgery of acute appendicitis during pregnancy may increase the risk of perinatal mortality and should not be delayed in diagnosis and surgery in pregnancy.

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“…A strong body of evidence suggests that preterm birth is associated with maternal systemic inflammatory conditions such as appendicitis [132][133][134][135], acute pyelonephritis [136][137][138], influenza [139][140][141], and sepsis [142]. The rates of spontaneous preterm birth in such conditions are 5.1% in appendicitis [133], 10.3% in acute pyelonephritis [138], and 5-30% in influenza [139].…”

Section: The Maternal Systemic and Intrauterine Local Inflammationmentioning

confidence: 99%

The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection byUreaplasmaspecies

Romero

Park

et al. 2019

Journal of Perinatal Medicine

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Objectives To determine the relationship between the intensity of the intra-amniotic inflammatory response and the gestational age at the time of diagnosis in cases with preterm premature rupture of membranes (PROM) and intra-amniotic infection caused by Ureaplasma spp. Methods A retrospective cohort study was conducted which included 71 women with preterm PROM and a positive amniotic fluid culture with Ureaplasma spp. Women with mixed intra-amniotic infections were excluded. The study population was classified into three groups according to gestational age: group 1, <26 weeks (extreme preterm PROM, n = 17); group 2, 26.0–33.9 weeks (moderate preterm PROM, n = 39); group 3, 34.0–36.9 weeks (late preterm PROM, n = 15). The intensity of the intra-amniotic and maternal inflammatory response was compared among the three groups. The intensity of the intra-amniotic inflammatory response was assessed by the concentration of amniotic fluid matrix metalloproteinase-8 (MMP-8) and white blood cell (WBC) count. The maternal inflammatory response was assessed by the concentration of C-reactive protein (CRP) and WBC count in maternal blood at the time of amniocentesis. Results (1) The median values of amniotic fluid MMP-8 concentration and WBC count were the highest in the extreme preterm PROM group and the lowest in the late preterm PROM group (P < 0.001 and P = 0.01, respectively); (2) the intensity of the maternal inflammatory response measured by maternal blood WBC count and CRP concentration was not significantly associated with gestational age at the time of diagnosis. Conclusion The earlier the gestational age at the time of PROM, the higher the intensity of the intra-amniotic inflammatory response in women with preterm PROM and intra-amniotic infection caused by Ureaplasma spp.

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Management and Outcomes of Appendectomy during Pregnancy

Cited by 23 publications

References 15 publications

Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies

Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies

Acute appendicitis in pregnancy: 50 case series, maternal and neonatal outcomes

The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection byUreaplasmaspecies

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