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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