Rate of negative appendectomy in pregnant women in Benin City, Nigeria.

AIM: This study was an analysis of women diagnosed with acute appendicitis in pregnancy, to appraise the maternal and fetal outcomes and explore the correlations with negative appendectomy.

MATERIAL AND METHODS: A retrospective study was undertaken at the University of Benin Teaching Hospital, Nigeria. The service delivery records of all pregnant women who underwent appendectomy for acute appendicitis from January 2000 to December 2009 were analyzed.

RESULTS: Among 16,173 deliveries, 23 pregnant women were diagnosed with acute appendicitis. The age of the women ranged between 15 and 34 years (median = 26 years), while the majority (65.2%) were nulliparous. The mean gestational age at presentation was 21.1 ± 6.9 weeks with up to 15 (65.2%) patients presenting in the second trimester. Eighteen (78.3%) patients had histopathologically proven appendicitis giving a negative appendectomy rate of 21.7%. Postoperative complications were noted in eight (34.8%) patients. Half of these occurred within the negative appendectomy group. The negative appendectomy group also contributed significantly to the adverse obstetric outcome: preterm labor, 8.7% of 21.7%, preterm delivery, 4.5% of 13.6% and a fetal loss rate of 4.3% of 13%. One maternal death occurred in the group with diseased appendix giving a maternal mortality rate of 4.3%.

CONCLUSIONS: While a higher index of suspicion among clinicians will ensure earlier diagnosis and improve the associated maternal and fetal prognosis, the need to reduce the negative laparotomy rate is highlighted by the high rate of adverse obstetric outcomes amongst the negative appendectomy group.