Comparative Outcomes of Appendectomy in Pregnant vs Non-Pregnant Women

Overview

This retrospective study analyzed appendectomy outcomes in 99 pregnant and 1796 non-pregnant women with suspected appendicitis. It highlights diagnostic challenges in pregnancy, surgical approaches, and postoperative outcomes, providing valuable insights from one of the largest single-center cohorts.

Background

Suspected appendicitis is the most common non-obstetric surgical indication during pregnancy, occurring in approximately 1:500 to 1:1000 pregnancies. Diagnosis is complicated by atypical presentations and physiological changes in pregnancy that affect clinical, laboratory, and imaging findings. Imaging guidelines recommend ultrasound first, with MRI as a secondary modality due to radiation concerns with CT. Surgical management, particularly laparoscopic appendectomy, is considered safe during pregnancy and preferred when feasible.

Data Highlights

Key Findings

• Pregnant women with suspected appendicitis often present with atypical clinical signs and laboratory findings due to physiological changes in pregnancy.
• Ultrasound is the first-line imaging modality; MRI is used when ultrasound is inconclusive, avoiding CT due to radiation risks.
• Laparoscopic appendectomy is safe and preferred during pregnancy, especially in the first and second trimesters.
• Negative appendectomy during pregnancy is associated with adverse neonatal outcomes, emphasizing the need for accurate diagnosis.
• Non-operative management of appendicitis during pregnancy is not recommended due to worse outcomes compared to surgery.
• The study provides one of the largest single-center datasets comparing pregnant and non-pregnant women undergoing appendectomy.

Clinical Implications

Clinicians should maintain a high index of suspicion for appendicitis in pregnant women despite atypical presentations and rely on a combination of clinical, laboratory, and imaging findings for diagnosis. Laparoscopic appendectomy remains the preferred surgical approach when feasible, balancing maternal and fetal safety. Avoidance of negative appendectomy is critical due to associated neonatal risks.

Conclusion

This large retrospective study underscores the diagnostic challenges and supports laparoscopic appendectomy as a safe and effective treatment for appendicitis during pregnancy. Accurate diagnosis and timely surgical intervention are essential to optimize maternal and neonatal outcomes.

References

1. Study Authors/University Hospital Augsburg/2023 -- Comparative Analysis of Appendectomy Outcomes in Pregnant Versus Non-Pregnant Women