Maternal and Neonatal Outcomes of Appendicitis in Pregnancy [19D

Abstract

INTRODUCTION: We sought to determine the differences in pregnancy outcomes seen in women with diagnosed appendicitis when compared to women who do not have this diagnosis. METHODS: A retrospective cohort study of 1,853,219 women in California with singleton, vertex, non-anomalous, term gestations was performed to assess the prevalence of maternal and neonatal outcomes in women with appendicitis during pregnancy as compared to unaffected women. Maternal outcomes included chorioamnionitis, placental abruption, cesarean delivery, post-partum hemorrhage, and maternal sepsis. Neonatal outcomes included preterm delivery (divided into <37, <34, and <32 weeks gestational age), intrauterine fetal demise (IUFD), respiratory distress syndrome (RDS), and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons. RESULTS: Women with appendicitis had an increased risk of adverse outcomes in pregnancy. Appendicitis was associated with a statistically significant increase in cesarean delivery (odds ratio [OR], 7.37; 95% confidence interval [CI], 4.58-11.84), preterm delivery prior to 37 weeks (OR, 11.92; CI, 7.85-18.09), and blood transfusion (OR 20.56, CI, 10.86-38.89). It was also associated with several statistically significant adverse neonatal outcomes, including intrauterine death (OR, 4.16 (CI, .56-30.88), respiratory distress syndrome (OR, 14.78; CI, 7.89-27.64), and neonatal death (OR 19.29, CI (5.70-65.19). CONCLUSION: Women with appendicitis in pregnancy are at higher risk of complications than all-comers, with a statistically significant rates of both preterm delivery, cesarean delivery, and neonatal death. Whether this increased risk was due to confounding factors, impact of surgical treatment, or disease pathophysiology, and how these risks can be mitigated through health care practice advancements deserves further consideration.