Abstract：
Clinical practice recommendations for the management of acute appendicitis in pregnancy are lacking.
To develop an evidence-informed, trustworthy guideline on the management of appendicitis in pregnancy. We aimed to address the questions of conservative or surgical management, and laparoscopic or open surgery for acute appendicitis.
We performed a systematic review, meta-analysis, and evidence appraisal using the GRADE methodology. A European, multidisciplinary panel of surgeons, obstetricians/gynecologists, a midwife, and 3 patient representatives reached consensus through an evidence-to-decision framework and a Delphi process to formulate the recommendations. The project was developed in an online authoring and publication platform (MAGICapp).
Research evidence was of very low certainty. We recommend operative treatment over conservative management in pregnant patients with complicated appendicitis or appendicolith on imaging studies (strong recommendation). We suggest operative treatment over conservative management in pregnant patients with uncomplicated appendicitis and no appendicolith on imaging studies (weak recommendation). We suggest laparoscopic appendectomy in patients with acute appendicitis until the 20th week of gestation, or when the fundus of the uterus is below the level of the umbilicus; and laparoscopic or open appendectomy in patients with acute appendicitis beyond the 20th week of gestation, or when the fundus of the uterus is above the level of the umbilicus, depending on the preference and expertise of the surgeon.
Through a structured, evidence-informed approach, an interdisciplinary panel provides a strong recommendation to perform appendectomy for complicated appendicitis or appendicolith, and laparoscopic or open appendectomy beyond the 20th week, based on the surgeon\'s preference and expertise.
IPGRP-2022CN210.
To develop an evidence-informed, trustworthy guideline on the management of appendicitis in pregnancy. We aimed to address the questions of conservative or surgical management, and laparoscopic or open surgery for acute appendicitis.
We performed a systematic review, meta-analysis, and evidence appraisal using the GRADE methodology. A European, multidisciplinary panel of surgeons, obstetricians/gynecologists, a midwife, and 3 patient representatives reached consensus through an evidence-to-decision framework and a Delphi process to formulate the recommendations. The project was developed in an online authoring and publication platform (MAGICapp).
Research evidence was of very low certainty. We recommend operative treatment over conservative management in pregnant patients with complicated appendicitis or appendicolith on imaging studies (strong recommendation). We suggest operative treatment over conservative management in pregnant patients with uncomplicated appendicitis and no appendicolith on imaging studies (weak recommendation). We suggest laparoscopic appendectomy in patients with acute appendicitis until the 20th week of gestation, or when the fundus of the uterus is below the level of the umbilicus; and laparoscopic or open appendectomy in patients with acute appendicitis beyond the 20th week of gestation, or when the fundus of the uterus is above the level of the umbilicus, depending on the preference and expertise of the surgeon.
Through a structured, evidence-informed approach, an interdisciplinary panel provides a strong recommendation to perform appendectomy for complicated appendicitis or appendicolith, and laparoscopic or open appendectomy beyond the 20th week, based on the surgeon\'s preference and expertise.
IPGRP-2022CN210.
摘要：
缺乏治疗妊娠期急性阑尾炎的临床实践建议。
为了建立一个有证据的，关于妊娠阑尾炎管理的可靠指南。我们旨在解决保守或手术管理的问题，和腹腔镜或开腹手术治疗急性阑尾炎。
我们进行了系统评价,荟萃分析，和使用等级方法进行证据评估。一个欧洲人,多学科外科医生小组，产科医生/妇科医生，助产士,3名患者代表通过证据决策框架和Delphi程序制定建议达成共识.该项目是在在线创作和出版平台（MAGICapp）中开发的。
研究证据的确定性非常低。在影像学检查中，我们建议对患有复杂性阑尾炎或阑尾结石的孕妇进行手术治疗，而不是保守治疗（强烈建议）。我们建议对无并发症阑尾炎且无阑尾结石的孕妇进行手术治疗，而不是保守治疗（弱推荐）。我们建议对急性阑尾炎患者进行腹腔镜阑尾切除术，直至妊娠20周，或当子宫底低于脐部水平时；妊娠20周以上急性阑尾炎患者的腹腔镜或开腹阑尾切除术，或者当子宫底高于脐部时，取决于外科医生的偏好和专业知识。
通过一个结构化的，循证方法，一个跨学科小组提供了一个强有力的建议，以进行复杂的阑尾炎或阑尾结石的阑尾切除术，20周后进行腹腔镜或开腹阑尾切除术,根据外科医生的偏好和专业知识。
IPGRP-2022CN210。
为了建立一个有证据的，关于妊娠阑尾炎管理的可靠指南。我们旨在解决保守或手术管理的问题，和腹腔镜或开腹手术治疗急性阑尾炎。
我们进行了系统评价,荟萃分析，和使用等级方法进行证据评估。一个欧洲人,多学科外科医生小组，产科医生/妇科医生，助产士,3名患者代表通过证据决策框架和Delphi程序制定建议达成共识.该项目是在在线创作和出版平台（MAGICapp）中开发的。
研究证据的确定性非常低。在影像学检查中，我们建议对患有复杂性阑尾炎或阑尾结石的孕妇进行手术治疗，而不是保守治疗（强烈建议）。我们建议对无并发症阑尾炎且无阑尾结石的孕妇进行手术治疗，而不是保守治疗（弱推荐）。我们建议对急性阑尾炎患者进行腹腔镜阑尾切除术，直至妊娠20周，或当子宫底低于脐部水平时；妊娠20周以上急性阑尾炎患者的腹腔镜或开腹阑尾切除术，或者当子宫底高于脐部时，取决于外科医生的偏好和专业知识。
通过一个结构化的，循证方法，一个跨学科小组提供了一个强有力的建议，以进行复杂的阑尾炎或阑尾结石的阑尾切除术，20周后进行腹腔镜或开腹阑尾切除术,根据外科医生的偏好和专业知识。
IPGRP-2022CN210。
