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Appendicectomy during pregnancy and the risk of preterm birth: A population data linkage study
Author(s) -
Ibiebele Ibinabo,
Schnitzler Margaret,
Nippita Tanya,
Ford Jane B.
Publication year - 2019
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12807
Subject(s) - medicine , obstetrics , pregnancy , appendicitis , gestational age , relative risk , population , premature birth , confidence interval , poisson regression , obstetrics and gynaecology , hazard ratio , surgery , genetics , environmental health , biology
Background Suspected appendicitis is a common non‐obstetric indication for emergency abdominal surgery during pregnancy. Aims Assess the risk of preterm birth and other maternal and neonatal adverse birth outcomes following appendicectomy during pregnancy. Materials and Methods Population‐based data linkage study of women with singleton births in New South Wales, Australia, 2002–2014. Pregnancies with appendicitis and appendicectomy were compared to pregnancies without appendicitis. Crude and adjusted hazard ratios ( aHR ) with 95% confidence intervals (CI) for preterm birth were estimated. Modified Poisson regression with robust variance was used to estimate crude and adjusted risk ratios ( aRR ) with 99% CI for other outcomes. Results Of 1 124 551 eligible pregnancies, 1024 (0.9/1000 pregnancies) had appendicitis and appendicectomy. Of these, 566 (55.3%) had laparoscopic and 458 (44.7%) had open appendicectomy. Appendicectomy at later gestational ages was associated with increasing rates of preterm birth. After adjustment for maternal and pregnancy factors, appendicectomy was associated with increased risk of preterm birth (overall aHR 1.73, 95% CI 1.42–2.09; planned aHR 2.08, 95% CI 1.60–2.72), maternal morbidity ( aRR 2.68, 99% CI 1.88–3.83) and neonatal morbidity ( aRR 1.42, 99% CI 1.03–1.94). However, there was no difference in perinatal mortality rates. Conclusion Appendicectomy during pregnancy is associated with increased risk of spontaneous and planned preterm birth, maternal and neonatal morbidity. Availability of resources to prevent or manage preterm labour should be considered when appendicectomy is performed at gestational ages of 20 weeks or more.