PULMONARY INJURY ASSOCIATED WITH APPENDICITIS IN PREGNANCY - WHO IS AT RISK

OBJECTIVE: Our purpose was to determine risk factors for pulmonary inj ury in women with antepartum appendicitis. STUDY DESIGN: This case-con trol study included 49 patients with appendicitis during pregnancy. Pa tients who had pulmonary injury composed the study group (n = 9); the control subjects had no injury (n = 40). Records were abstracted for g estational age at surgery, type of anesthesia, presenting symptoms, fi ndings on physical examination, vital signs, laboratory test results, use of tocolytics or antibiotics, and fluid management. Pulmonary inju ry was characterized by dyspnea, tachypnea, Pao(2) less than or equal to 70 mm Hg, and an abnormality on chest radiography. RESULTS: Pulmona ry injury developed in nine study patients (18%) (adult respiratory di stress syndrome, n = 2; pulmonary edema or infiltrates, n = 7) as a co mplication of appendicitis during pregnancy. All study group patients were at > 20 weeks' gestation compared with 27 of 40 (67%) control sub jects (p = 0.05). Univariate analysis showed that fluid overload great er than or equal to 4 L, maximum respiratory rate > 24 breaths/min, ma ximum heart rate > 110 beats/min, maximum temperature greater than or equal to 100.4 degrees F, general anesthesia, and tocolytic use were s ignificant (p < 0.005). By multivariate analysis with the use of stepw ise logistic regression a model of fluid overload greater than or equa l to 4 L, respiratory rate > 24 breaths/min, maximum temperature great er than or equal to 100.4 degrees F, and tocolytic usage would predict 99% of injury cases. CONCLUSIONS: latrogenic factors such as injudici ous fluid management and tocolytic use can greatly increase the risk f or pulmonary injury with antepartum appendicitis.