¡¡ NEW YORK (Reuters Health) - Removal of a normal appendix during pregnancy is associated with an increased risk of fetal loss or early delivery, according to a report in the October issue of the Journal of the American College of Surgeons.
"It is important to minimize the number of negative appendectomies performed in pregnant women in order to have the most impact on improving fetal outcomes," Dr. Marcia L. McGory, told Reuters Health. "A potential mechanism to improve diagnostic accuracy is more liberal use of preoperative imaging in pregnant women to confirm the diagnosis prior to operation."
Dr. McGory from the David Geffen School of Medicine at the University of California Los Angeles and colleagues evaluated outcomes of nearly 95,000 women, of whom more than 3000 were pregnant, undergoing appendectomy.
The negative appendectomy rate for pregnant women (23%) was significantly higher than for nonpregnant women (18%), the authors report.
Among pregnant women, fetal loss rates were twice as high with removal of a normal appendix (4%) than with simple appendicitis (2%) and were increased further with complicated appendicitis (6%).
Early delivery rates were also higher after negative appendectomy (10%) and complicated appendicitis (11%) than after simple appendicitis (4%), the researchers note.
Fetal loss rates were higher after laparoscopic appendectomy (7%) than after open appendectomy (3%).
"Since there is a risk of fetal loss and early delivery in pregnant women undergoing negative appendectomy, it appears that improved diagnostic accuracy is needed prior to taking pregnant women to the operating room for appendectomy," Dr. McGory continued. "Neither ultrasound nor MRI have a harmful effect on the fetus and should probably be utilized more frequently in pregnant women to try to obtain a definitive diagnosis prior to going to the operating room."
"There is definitely a need for further studies evaluating pregnant women undergoing appendectomy," Dr. McGory added. "Since the administrative database we used does not contain a lot of clinical variables, further work is needed either by retrospective medical record review or prospective data collection of pregnant women undergoing appendectomy."
J Am Coll Surg 2007;205:535-540.
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