Appendicitis in Pregnancy

Author(s):
Georgia Vasileiou; Ahmed Eid; Sinong Qian; Gerd Daniel Pust; Rishi Rattan; Nicholas Namias; Andreas Larentzakis; Haytham Kaafarani; Daniel Yeh

Background:

To compare the presentation, management, and outcomes of appendicitis in pregnant and non-pregnant females of childbearing age (18–45 years).

Methods:

This was a post-hoc analysis of a prospectively collected database (01/17-06/18) from 28 centers in America. We compared pregnant and non-pregnant females’ demographics, clinical presentation, labs, imaging, management, and clinical outcomes.

Results:

Out of 3,597 subjects, 1,010 (28%) were females of childbearing age, and 41 (4%) were pregnant: mean age was 30± 8 years at median gestational age 15 [10-23] weeks. The two groups had similar demographics and clinical presentation, but there were differences in management and outcomes (Table 1 and 2). In pregnant subjects, abdominal ultrasound (U/S) plus MRI was the most frequently used imaging (41%) followed by MRI alone (29%), U/S alone (22%), CT (5%), and no imaging (2%). Despite similar AAST EGS Clinical and Imaging Grade at presentation, pregnant subjects were more likely to be treated with antibiotics alone (15% vs 4%, p=.008). Pregnant subjects were less likely to have simple appendicitis and were more likely to have complicated (perforated or gangrenous) appendicitis or a normal appendix. With the exception of index hospital length of stay, there were no significant differences between groups in clinical outcomes at index hospitalization and at 30-days.

Conclusions:

Almost 1 in 20 women of childbearing age presenting with appendicitis is pregnant. Appendicitis most commonly affects women in early- to mid-pregnancy. Compared to non-pregnant women of childbearing age, pregnant women presenting with appendicitis undergo non-operative management more often and are less likely to have simple appendicitis. When compared to non-pregnant patients, they have similar clinical outcomes at both index hospitalization, and 30-days post discharge.