Is Appendectomy During Late Stages of Pregnancy Associated with an Increased Cesarean Delivery Rate? – a Retrospective Analysis of One Center During 10 Years

Abstract

Introduction

About one in 500 pregnant women requires a surgical intervention that is not pregnancy-related. One of the most common surgical interventions during pregnancy is appendectomy. The primary aim of this study was to assess surgical access of appendectomy during pregnancy and pregnancy outcome. Secondary outcomes were clinical symptoms and diagnostics as well as histopathological analysis.

Methods and Material

This is a single-center retrospective data analysis conducted at a tertiary perinatal center. A digital search of the hospital record archive was conducted focusing on pregnant women beyond 24 0/7 weeks of pregnancy encoding appendectomy. Descriptive statistical analysis was performed.

Results

Between January 2013 and January 2023, a total of 20 appendectomies were performed during pregnancy with gestational age beyond 24 0/7 weeks of pregnancy. All of them were performed as lower midline laparotomy. The rate of appendix perforation was 3/20 (15.0%). 19/20 patients (95.0%) delivered via cesarean. In 7/20 patients (35.0%) appendectomy was performed during cesarean delivery due to incidental finding of irritated or abnormal vermiform appendix. In the pathological work-up, only 2/7 (28.6%) of these subjects had inflammation.

Conclusion

In this small monocentric cohort, only open appendectomies were performed. Our data indicate that it is safe to perform open appendectomy during pregnancy if necessary. In this small patient group, there was an increase in simultaneous cesarean deliveries.

Zusammenfassung

Einleitung

Eine von 500 schwangeren Frauen benötigt während der Schwangerschaft einen operativen Eingriff, der nicht mit der Schwangerschaft in Zusammenhang steht. Die Appendektomie stellt einen der häufigsten chirurgischen Eingriffe während der Schwangerschaft dar. Hauptziel dieser Studie war es, den Operationszugang sowie das Schwangerschafts-Outcome nach Appendektomie zu beurteilen. Sekundäre Outcomes waren klinische Symptome und Diagnosen sowie die histopathologische Analyse.

Methoden und Material

Es handelt sich hier um eine retrospektive monozentrische Datenanalyse, die an einem Perinatalzentrum Level 1 durchgeführt wurde. Es wurde eine digitale Suche des Krankenhausaktenarchivs nach schwangeren Frauen mit einem Gestationsalter von mehr als 24 0+7 Wochen und einer Appendektomie-Kodierung durchgeführt. Eine deskriptive statistische Analyse wurde durchgeführt.

Ergebnisse

Zwischen Januar 2013 und Januar 2023 wurden insgesamt 20 Appendektomien bei schwangeren Frauen mit einem Gestationsalter von mehr als 24+0 SSW durchgeführt. Alle Eingriffe wurden als Pfannenstielschnitt durchgeführt. Insgesamt hatten 3/20 Frauen (15,0%) einen Blinddarmdurchbruch. 19/20 der Patientinnen (95,0%) wurden per Sectio caesarea entbunden. Bei 7/20 der Patientinnen (35,0%) wurde die Appendektomie aufgrund des Zufallsbefunds eines gereizten bzw. abnormen Wurmfortsatzes während einer Kaiserschnittentbindung durchgeführt. Bei der pathologischen Abklärung fand sich nur bei 2/7 (28,6%) dieser Patientinnen eine Entzündung.

Schlussfolgerung

In dieser kleinen monozentrischen Kohorte wurden nur offene Appendektomien durchgeführt. Unsere Daten zeigen, dass – falls ein Eingriff nötig ist – eine offene Appendektomie relativ gefahrlos während der Schwangerschaft durchgeführt werden kann. Diese kleine Patientinnengruppe hatte einen höheren Anteil gleichzeitiger Kaiserschnittentbindungen.

Keywords

appendectomy in pregnancy - appendicitis in pregnancy - cesarean section - surgical intervention pregnancy - imaging diagnostics appendicitis

Schlüsselwörter

Appendektomie in der Schwangerschaft - Appendizitis in der Schwangerschaft - Sectio caesarea - operativer Eingriff in der Schwangerschaft - diagnostische Bildgebung und Appendizitis

Publication History

Received: 03 November 2023

Accepted after revision: 20 February 2024

Article published online:
10 April 2024

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