title: Acute appendicitis in pregnancy--risk factors associated with principal outcomes: a case control study.
abstract: BACKGROUND
  The aim of this study was to determine the risk factors associated with the principal outcomes in acute appendicitis during pregnancy: appendix-perforation, and maternal and fetal mortality and maternal morbidity.
  
  
  METHODS
  Fifty-two pregnant women who were diagnosed and operated upon acute appendicitis in Dicle University Hospital, Diyarbakir, Turkey were presented.
  
  
  RESULTS
  The frequency of appendicitis was higher in second trimester. On laparotomy 21 patients had perforated, 29 patients had non-perforated and 2 patients had normal appendix. Interval between symptom onset and operation was found as the only predictive variable, which was independently associated with the presence of appendiceal perforation. There was a significant difference between perforated and non-perforated patients about the rate of complications (52% vs. 17%). Gestational age (p=0.036), interval between symptom onset and operation (p=0.018) and white blood cell count (p=0.025) were the variables related with preterm labor. Tocolytic treatment after the onset of contractions could not prevent preterm labor. The rate of fetal mortality was 8%.
  
  
  CONCLUSIONS
  Presence of perforation is the only predictive factor for maternal morbidity. The aim of the surgeon should be operating the patient before perforation. An observation period may be essential in equivocal patients, but should be individualized according to duration of symptoms and findings of physical examination. The interval between the symptom onset and operation should never exceed 20 hours. Tocolytics should be ordered for the patients with delayed presentation and advanced gestational age in order to prevent preterm labor and fetal loss.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey. gyilmaz@dicle.edu.tr <gyilmaz@dicle.edu.tr>
authors.forename: Hatice Gulsen
authors.initials: HG
authors.lastname: Yilmaz
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Akgun
authors.forename: Bilsel
authors.initials: B
authors.lastname: Bac
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Celik
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005313:Fetal Death; D006801:Humans; D007416:Intestinal Perforation; D016015:Logistic Models; D008428:Maternal Mortality; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011256:Pregnancy Outcome; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal