Operative and non-operative management of acute appendicitis during pregnancy: a population-based study

Purpose: Acute appendicitis during pregnancy poses unique challenges due to altered anatomical and physiological dynamics and concern about foetal well-being. This study aimed to assess management strategies and outcomes of acute appendicitis during pregnancy, focusing on non-operative management versus surgical intervention. Methods: The study is based on the computerized healthcare utilization database of Lombardy. Results: In Lombardy, a total of 1,231,040 deliveries were identified. Acute appendicitis during pregnancy occurred in 0.03% of cases, with 74.49% of these cases classified as uncomplicated. Appendicitis during pregnancy was associated with worse maternal and perinatal outcomes. Among uncomplicated cases, 38.46% were treated with non-operative management. Perinatal outcomes did not significantly differ between non-operative management and surgery groups. Additionally, a declining trend in surgical treatment over the study period was observed (P = 0.0477), possibly indicating a shift towards conservative management. Conclusion: The findings suggest that non-operative management may be a viable option for selected pregnant patients with uncomplicated appendicitis, potentially avoiding surgical complications and allowing for faster recovery. Further research is warranted to validate these findings, explore evolving trends, and refine clinical guidelines for managing acute appendicitis during pregnancy.