Objective: To compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis.
Design: Population-based matched cohort study.
Setting: United States of America.
Sample: A total of 7114 women with appendicitis among 7,037,386 births.
Methods: Logistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest.
Main outcome measures: Maternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis.
Results: There was an overall incidence of 101.1 cases of appendicitis per 100,000 births. Appendicitis was diagnosed in 35,570 nonpregnant women during the corresponding time frame. Peritonitis occurred in 20.3% of pregnant women with appendicitis, with an adjusted OR of 1.3 (95% CI 1.2-1.4) when compared with nonpregnant women with appendicitis. In pregnancy, there was an almost two-fold increase in sepsis and septic shock, transfusion, pneumonia, bowel obstruction, postoperative infection and length of stay >3 days. Whereas 5.8% of appendicitis cases among pregnant women were managed conservatively, they were associated with a considerably increased risk of shock, peritonitis and venous thromboembolism as compared to surgically managed cases.
Conclusions: Compared with nonpregnant women, pregnant women with acute appendicitis have higher rates of adverse outcomes. Conservative management should be avoided given the serious risk of adverse outcomes in pregnancy.
Keywords: Appendicitis; maternal outcomes; peritonitis; postoperative complications; pregnancy.
© 2014 Royal College of Obstetricians and Gynaecologists.