Unnecessary appendectomy risky in pregnant women

By Will Boggs, MD

NEW YORK (Reuters Health) - Unnecessary surgery to remove a normal appendix during pregnancy increases the risk that mom-to-be will lose her baby or that she will deliver early, research indicates.

"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. Marcia L. McGory, told Reuters Health.

"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," she added.

McGory from the David Geffen School of Medicine at the University of California Los Angeles and colleagues looked at the outcomes of nearly 95,000 women who had their appendix removed. More than 3,000 of the women were pregnant at the time of surgery.

The researchers found that far more pregnant than non-pregnant women had unnecessary appendectomies (23 percent versus 18 percent).

Among pregnant women, fetal loss rates were twice as high with removal of a normal appendix (4 percent) than with simple appendicitis (2 percent) and were increased further with complicated appendicitis (6 percent).

Early delivery rates were also higher after unnecessary appendectomy (10 percent) and complicated appendicitis (11 percent) than after simple appendicitis (4 percent), the researchers note.

"There is definitely a need for further studies evaluating pregnant women undergoing appendectomy," McGory said. The "more liberal use" of pre-surgery imaging in pregnant women may help confirm the diagnosis prior to operation and reduce the number of unnecessary operations performed, McGory suggested.

SOURCE: Journal of the American College of Surgeons, October 2007.