Appendectomy during pregnancy: rates, safety, and outcomes over
a five-year period. A hospital-based follow-up study
PG Lindqvist,a,b H Pettersson,b M
Dahlberg, b,c G Sandblom,b,c L
Boström, b,c
aDepartment of Gynecology and Obstetrics,bDepartment of Clinical Science and EducationcDepartment of Surgery, Department of Clinical Science
and Education, South General Hospital (Södersjukhuset), Karolinska
Institute, Stockholm, Sweden
Correspondence
Lennart Boström,
Department of Surgery,
South Stockholm General Hospital (Södersjukhuset),
Clinical Science and Education, Karolinska Institute,
SE-11883 Stockholm, Sweden.
E-mail: Lennart.bostrom@regionstockholm.se
Abstract 250 words
Paper 2547 words
Key words: Pregnancy, rate, complications, appendectomy,
appendicitis
Abstract
Objective: To assess the outcome of pregnancy after
appendectomy, the mode of surgery used, appendectomy rates and
complications.
Design: A prospective cohort study of pregnant women undergoing
appendectomy.
Setting: All appendectomies at South Stockholm General
Hospital, December 2015 to February 2021.
Population: Pregnant women undergoing appendectomy.
Methods : Data on preoperative imaging, surgical method,
intraoperative findings, microscopic findings, hospital stay, pregnancy,
and 30-day complications were prospectively recorded in a local
appendectomy register.
Results: During the study period, 50 pregnant women underwent
appendectomy of 38 199 women giving birth. During the same period 793
non-pregnant women underwent appendectomy and served as controls. No
differences in preterm delivery (4.5% vs. 5.6%), small-for-gestational
age (2.3% vs. 6.2%), or mode of delivery (cesarean delivery 18.2% vs.
20.4%) were observed between pregnant women with or without
appendectomy. There were no cases of perforated appendix in the second
half of pregnancy. However, women with gestational age > 20
weeks more frequently had an innocent appendix compared to those
operated < 20 gestational weeks (4/11 vs. 2/39,p = 0.005). Laparoscopic surgery was used in 92% of
appendectomies < 20 weeks gestation. The appendectomy
rate was three times lower during the second half of pregnancy.
Conclusion: Appendicitis in pregnancy is not a threat as long
as surgery is conducted as soon as possible. Although a low threshold
for surgery may increase the risk of finding an innocent appendix, this
is outweighed by the lower risk for perforation and serious adverse
events such as fetal loss or preterm delivery.