Appendicectomy During Pregnancy and the Risk of Preterm Birth: A Population Data Linkage Study

Abstract

(Aust N Z J Obstet Gynaecol. 2019;59:45–53) The most common emergency nonobstetric abdominal surgery performed in parturients is appendicectomy, which occurs in ∼0.3% of pregnancies. Establishing the diagnosis of appendicitis is more challenging in pregnant women as a result of the physiological changes of pregnancy and the many non-specific symptoms experienced during normal pregnancy. In addition, the use of ultrasound to make the diagnosis is less effective due to the presence of the gravid uterus and computed tomography scanning is sometimes avoided to prevent fetal radiation exposure. Appendiceal perforation may occur when there are delays in the diagnosis and treatment of appendicitis, and this complication is associated with adverse pregnancy outcomes. Appendicectomy is also associated with adverse fetal outcomes, including preterm birth, but higher rates of serious outcomes such as fetal loss and preterm labor have been reported with perforation. The current study was undertaken to examine the risk of preterm birth in parturients undergoing appendicectomy, with secondary aims of assessing the risk of other adverse maternal and neonatal outcomes as well as the effect of csurgical approach (laparoscopic or open) on these outcomes.