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Apandisit ile Komplike Gebeliklerin Cerrahi Tedavisi ve Gebelik Sonuçları: Obstetrisyen Görüşü

Year 2015, Volume: 16 Issue: 2, 43 - 49, 01.08.2015

Abstract

Amaç: Gebeliğinde apendektomi yapılan hastaların gebelik sonuçlarının değerlendirilmesi.Gereç ve Yöntemler: 2010-2014 yılları arasında apendektomi yapılan hastalar retrospektif olarak incelendi. Tüm hastaların gebelik sonuçları üniversite kayıt sistemi ve telefon görüşmeleri ile takip edildi. Hastalar yaş, gebelik yaşı, klinik ve laboratuvar muayeneleri, görüntüleme çalışmaları,
acil servis ve operasyon arasındaki ortalama zaman, ortalama operasyon süresi, gebelik sonucu ve apandiksin patoloji sonucuna göre
değerlendirildi.
Bulgular: Otuz dokuz hasta çalışmaya dahil edildi. Otuz dokuz hastanın 16’sı ilk, 15’i ikinci ve 8’i gebeliğin üçüncü trimesterindeydi.
Üç hastaya laparoskopik apendektomi kalanlarına laparatomi yapıldı. Apendiksin patolojik değerlendirilmesinde, yedi hasta (17%)
normal apendiks, dört hasta perfore apendiks, bir hasta nöro-endokrin tümor ve kalanları apandisit saptandı. Operasyon sonrası iki
missed abortus meydana gelirken kalanları canlı doğum yaptı. Bunlardan altısı preterm ve otuz biri term doğum yaptı. On iki hasta
vajinal yolla ve kalanları sezaryen yoluyla doğurtuldu. Yirmi hasta gebeliğin birinci yarısında (grup 1) ve 19 hasta gebeliğin ikinci
yarısındaydı (grup 2). Gruplar arasında operasyon zamanı ve acile kabul ile operasyon arasındaki ortalama zaman aralığı açısıdan
anlamlı farklılık yoktu.
Sonuç: Gecikmiş operasyon ve negatif apendektomi olumsuz gebelik sonuçlarına neden olabilir. Şüpheli olgulardaki izlem tedavisi
negatif apendektomi oranlarını düşürebilir; ancak aynı zamanda perforasyona neden olabilir. Bilgisayarlı tomografi ve manyetik
rezonans görüntüleme, ultrasonografinin net olmadığı zaman düşünülmelidir. Erken doğum tehditini önlemek için tokolitik rejimler
uygulanabilir. Doğum şekli için obstetrik endikasyonlar geçerlidir.

References

  • 1. Sharp HT. The acute abdomen during pregnancy. Clin Obstet Gynecol 2002; 45: 405-13.
  • 2. Upadhyay A, Stanten S, Kazantsev G, Horoupian R, Stanten A. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc 2007; 21: 1344-8.
  • 3. Brown JJ, Wilson C, Coleman S, Joypaul BV. Appendicitis in pregnancy: an ongoing diagnostic dilemma. Colorectal Dis 2009; 11: 116-22.
  • 4. Abbasi N, Patenaude V, Abenhaim HA. Evaluation of obstetrical and fetal outcomes in pregnancies complicated by acute appendicitis. Arch Gynecol Obstet 2014; 290: 661-7.
  • 5. Hee P, Viktrup L. The diagnosis of appendicitis during pregnancy and maternal and fetal outcome after appendectomy. Int J Gynecol Obstet 1999; 65: 129-35.
  • 6. Tracey M, Fletcher HS. Appendicitis in pregnancy. Am Surg 2000; 66: 555-9.
  • 7. Wittich AC, DeSantis RA, Lockrow EG. Apendectomy during pregnancy: a survey of two army medical activities. Mil Med 1999; 164: 671-4.
  • 8. Babler A. Perforative appendicitis complicating pregnancy. JAMA 1908; 51: 1310-3.
  • 9. Melnick DM, Wahl WL, Dalton VK. Management of general surgical problems in the pregnant patient. Am J Surg 2004; 187 :170-80.
  • 10. McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007; 205: 534-40.
  • 11. Hodjati H, Kazerooni T. Location of the appendix in the gravid patient: a re-evaluation of the established concept. Int J Gynaecol Obstet 2003; 81: 245-7.
  • 12. Lim HK, Bae SH, Seo GS. Diagnosis of acute appendicitis in pregnant women:value of sonography. AJR Am J Roentgenol 1992; 159 :539-42.
  • 13. Mazze RI, Källén B. Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 1991; 77: 835-40.
  • 14. Yilmaz HG, Akgun Y, Bac B, Celik Y. Acute appendicitis in pregnancy--risk factors associated with principal outcomes: a case control study. Int J Surg 2007; 5: 192-7.
  • 15. Thompson MM, Kudla AU, Chisholm CB. Appendicitis during pregnancy with a normal MRI. West J Emerg Med 2014; 15: 652-4.
  • 16. Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 2008; 112: 333- 40.
  • 17. Ames Castro M, Shipp TD, Castro EE, Ouzounian J, Rao P. The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis. Am J Obstet Gynecol 2001; 184: 954-7.
  • 18. Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK. CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 2007; 244: 784-90.
  • 19. Freeland M, King E, Safcsak K, Durham R. Diagnosis of appendicitis in pregnancy. Am J Surg 2009; 198: 753-8.
  • 20. Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007; 188: 1447-74.
  • 21. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology 2006; 238: 891-9.
  • 22. Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 2004; 18: 237-41.
  • 23. Yaghoubian A, Kaji AH, Lee SL. Laparoscopic versus open appendectomy: outcomes analysis. Am Surg 2012; 78: 1083-6.
  • 24. Fatum M, Rojansky N. Laparoscopic surgery during pregnancy. Obstet Gynecol Surv 2001; 56: 50-9.
  • 25. Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 2012; 99: 1470-8.
  • 26. Walsh CA, Tang T, Walsh SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 2008; 6: 339-44.
  • 27. Sadot E, Telem DA, Arora M, Butala P, Nguyen SQ, Divino CM. Laparoscopy: a safe approach to appendicitis during pregnancy. Surg Endosc 2010; 24: 383-9.
  • 28. Friedman JD, Ramsey PS, Ramin KD, Berry C. Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol 2002; 99: 512-3.
  • 29. Wu JM, Chen KH, Lin HF, Tseng LM, Tseng SH, Huang SH. Laparoscopic appendectomy in pregnancy. J Laparoendosc Adv Surg Tech A 2005; 15: 447-50.
  • 30. Lyass S, Pikarsky A, Eisenberg VH, Elchalal U, Schenker JG, Reissman P. Is laparoscopic appendectomy safe in pregnant women? Surg Endosc 2001; 15: 377-9.
  • 31. Kilpatrick CC, Monga M. Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 2007; 34: 389-402.
  • 32. Pastore PA, Loomis DM, Sauret J. Appendicitis in pregnancy. J Am Board Fam Med 2006; 19: 621-6.
  • 33. Maslovitz S, Gutman G, Lessing JB, Kupferminc MJ, Gamzu R. The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest 2003; 56: 188-91.
  • 34. Ito K, Ito H, Whang EE, Tavakkolizadeh A. Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 2012; 203: 145-50.
  • 35. McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007; 205: 534-40.
  • 36. Kapan S, Bozkurt MA, Turhan AN, Gönenç M, Alış H. Management of acute appendicitis in pregnancy. Ulus Travma Acil Cerrahi Derg 2013; 19: 20-4.
  • 37. Kort B, Katz V, Watson W. The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet 1993; 177: 371-6.
  • 38. Hunt MG, Martin JN Jr, Martin RW, Meeks GR, Wiser WL, Morrison JC. Perinatal aspects of abdominal surgery for nonobstetric disease. Am J Perinatol 1989; 6: 412-7

Pregnancy Outcomes and Surgical Management of Pregnancy Complicated By Appendicitis: Obstetrician View

Year 2015, Volume: 16 Issue: 2, 43 - 49, 01.08.2015

Abstract

Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix. Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17%) had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1) and 19 patients were in the second half of the pregnancy (group 2). There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode.

References

  • 1. Sharp HT. The acute abdomen during pregnancy. Clin Obstet Gynecol 2002; 45: 405-13.
  • 2. Upadhyay A, Stanten S, Kazantsev G, Horoupian R, Stanten A. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy. Surg Endosc 2007; 21: 1344-8.
  • 3. Brown JJ, Wilson C, Coleman S, Joypaul BV. Appendicitis in pregnancy: an ongoing diagnostic dilemma. Colorectal Dis 2009; 11: 116-22.
  • 4. Abbasi N, Patenaude V, Abenhaim HA. Evaluation of obstetrical and fetal outcomes in pregnancies complicated by acute appendicitis. Arch Gynecol Obstet 2014; 290: 661-7.
  • 5. Hee P, Viktrup L. The diagnosis of appendicitis during pregnancy and maternal and fetal outcome after appendectomy. Int J Gynecol Obstet 1999; 65: 129-35.
  • 6. Tracey M, Fletcher HS. Appendicitis in pregnancy. Am Surg 2000; 66: 555-9.
  • 7. Wittich AC, DeSantis RA, Lockrow EG. Apendectomy during pregnancy: a survey of two army medical activities. Mil Med 1999; 164: 671-4.
  • 8. Babler A. Perforative appendicitis complicating pregnancy. JAMA 1908; 51: 1310-3.
  • 9. Melnick DM, Wahl WL, Dalton VK. Management of general surgical problems in the pregnant patient. Am J Surg 2004; 187 :170-80.
  • 10. McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007; 205: 534-40.
  • 11. Hodjati H, Kazerooni T. Location of the appendix in the gravid patient: a re-evaluation of the established concept. Int J Gynaecol Obstet 2003; 81: 245-7.
  • 12. Lim HK, Bae SH, Seo GS. Diagnosis of acute appendicitis in pregnant women:value of sonography. AJR Am J Roentgenol 1992; 159 :539-42.
  • 13. Mazze RI, Källén B. Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 1991; 77: 835-40.
  • 14. Yilmaz HG, Akgun Y, Bac B, Celik Y. Acute appendicitis in pregnancy--risk factors associated with principal outcomes: a case control study. Int J Surg 2007; 5: 192-7.
  • 15. Thompson MM, Kudla AU, Chisholm CB. Appendicitis during pregnancy with a normal MRI. West J Emerg Med 2014; 15: 652-4.
  • 16. Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 2008; 112: 333- 40.
  • 17. Ames Castro M, Shipp TD, Castro EE, Ouzounian J, Rao P. The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis. Am J Obstet Gynecol 2001; 184: 954-7.
  • 18. Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK. CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 2007; 244: 784-90.
  • 19. Freeland M, King E, Safcsak K, Durham R. Diagnosis of appendicitis in pregnancy. Am J Surg 2009; 198: 753-8.
  • 20. Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007; 188: 1447-74.
  • 21. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology 2006; 238: 891-9.
  • 22. Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 2004; 18: 237-41.
  • 23. Yaghoubian A, Kaji AH, Lee SL. Laparoscopic versus open appendectomy: outcomes analysis. Am Surg 2012; 78: 1083-6.
  • 24. Fatum M, Rojansky N. Laparoscopic surgery during pregnancy. Obstet Gynecol Surv 2001; 56: 50-9.
  • 25. Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 2012; 99: 1470-8.
  • 26. Walsh CA, Tang T, Walsh SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 2008; 6: 339-44.
  • 27. Sadot E, Telem DA, Arora M, Butala P, Nguyen SQ, Divino CM. Laparoscopy: a safe approach to appendicitis during pregnancy. Surg Endosc 2010; 24: 383-9.
  • 28. Friedman JD, Ramsey PS, Ramin KD, Berry C. Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol 2002; 99: 512-3.
  • 29. Wu JM, Chen KH, Lin HF, Tseng LM, Tseng SH, Huang SH. Laparoscopic appendectomy in pregnancy. J Laparoendosc Adv Surg Tech A 2005; 15: 447-50.
  • 30. Lyass S, Pikarsky A, Eisenberg VH, Elchalal U, Schenker JG, Reissman P. Is laparoscopic appendectomy safe in pregnant women? Surg Endosc 2001; 15: 377-9.
  • 31. Kilpatrick CC, Monga M. Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 2007; 34: 389-402.
  • 32. Pastore PA, Loomis DM, Sauret J. Appendicitis in pregnancy. J Am Board Fam Med 2006; 19: 621-6.
  • 33. Maslovitz S, Gutman G, Lessing JB, Kupferminc MJ, Gamzu R. The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest 2003; 56: 188-91.
  • 34. Ito K, Ito H, Whang EE, Tavakkolizadeh A. Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 2012; 203: 145-50.
  • 35. McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007; 205: 534-40.
  • 36. Kapan S, Bozkurt MA, Turhan AN, Gönenç M, Alış H. Management of acute appendicitis in pregnancy. Ulus Travma Acil Cerrahi Derg 2013; 19: 20-4.
  • 37. Kort B, Katz V, Watson W. The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet 1993; 177: 371-6.
  • 38. Hunt MG, Martin JN Jr, Martin RW, Meeks GR, Wiser WL, Morrison JC. Perinatal aspects of abdominal surgery for nonobstetric disease. Am J Perinatol 1989; 6: 412-7
There are 38 citations in total.

Details

Other ID JA42FH42VF
Journal Section Research Article
Authors

Deniz Şimşek This is me

Özgür Deniz Turan This is me

Ahmet Mete Ergenoğlu This is me

Halit Batuhan Demir This is me

Taylan Özgür Sezer This is me

Çağdaş Şahin This is me

Publication Date August 1, 2015
Published in Issue Year 2015 Volume: 16 Issue: 2

Cite

EndNote Şimşek D, Turan ÖD, Ergenoğlu AM, Demir HB, Sezer TÖ, Şahin Ç (August 1, 2015) Pregnancy Outcomes and Surgical Management of Pregnancy Complicated By Appendicitis: Obstetrician View. Meandros Medical And Dental Journal 16 2 43–49.