What does this article add?
- Acute appendicitis during pregnancy could increase the rate of
Cesarean sections.
- Cesarean section could increase the risk of early puerperal
appendicitis.
-
Introduction
Acute appendicitis (AA) is the most common cause of non-obstetric acute
abdominal pain during pregnancy.1 It occurs in 1/2000
to 1/500 pregnancies,2,3 and it is exceedingly rare in
the third trimester, possibly due to the protective effects of hormonal
and immunological changes during pregnancy.4-6 The
diagnosis during pregnancy is complicated due to either nonspecific
signs and symptoms or inconclusive laboratory test results due to
physiological changes or limited options for radiological
imaging.7 During pregnancy, if not (partly) fixed or
retroperitoneal, the appendix is slightly displaced upward due to the
growing uterus, especially in the second and third trimesters. Still, it
returns to its previous location just ten days after
birth.8-10
AA is the most common non-urogenital puerperal condition, being the most
frequent cause for hospital readmission in
puerperium.11 Postpartum diagnosis of AA is
challenging due to atypical presentation and broad differential
diagnosis, including urinary infections, pneumonia, cholecystitis, and
many gynecological infections, such as puerperal endometritis and
tubo-ovarian abscess.12 However, perforated AA is a
frequent cause of postpartum sepsis, second only to puerperal
sepsis.13
Many studies have shown that AA during pregnancy can result in preterm
delivery, while fetal loss is significant after perforated
AA.14-16 However, due to the low number of cases in
all these studies, the significance of the relationship between
appendectomy for AA and pregnancy complications and delivery outcomes is
misinterpreted.17 Also, the relationships between
appendectomy for AA in puerperium and the routes of previous delivery
are not previously reported. In this study, the authors evaluated the
association between appendectomy for AA during pregnancy and puerperium
and birth outcomes.
Material and Methods