Objective: To compare between conservative management and appendectomy for acute appendicitis during pregnancy by trimester. Design: Retrospective cohort study. Setting: 632 acute-care hospitals in Japan. Population: Pregnant women diagnosed with acute appendicitis. Methods: We conducted a large nationwide study using a national inpatient database from July 2010 to March 2022. Comparisons were conducted using multivariable analysis with generalized estimating equations. Main Outcome Measures: Preterm labor, preterm delivery, or abortion, antepartum hemorrhage, duration of hospitalization, and duration of antibiotic use. Results: 3,158 individuals were eligible. Proportions of conservative management versus appendectomy by trimester were 507 (49.1%) vs. 525 (50.9%) in the first, 690 (44.6%) vs. 856 (55.4%) in the second, and 337 (58.1%) vs. 243 (41.9%) in the third. In the second trimester, appendectomy had a higher rate of preterm delivery, preterm labor, or abortion (OR 2.91; 95% CI 1.62–5.25). Antepartum hemorrhage occurred more frequently for appendectomy in the first (OR 2.12; 95% CI 1.31–3.43) and third (OR 2.43; 95% CI 1.79–3.31) trimesters. Appendectomy had longer duration of hospitalization in the second (2.15 days; 95% CI 1.14–3.17 days) and third (3.97 days; 95% CI 2.22–5.71 days) trimesters. Antibiotic use duration was shorter for appendectomy in the first (−1.20 days; 95% CI −1.51 to −0.90 days) and second (−0.61 days; 95% CI −0.90 to −0.32 days) trimesters. Conclusions: Clinical outcomes of acute appendicitis during pregnancy vary by trimester. Considering the appendectomy risks, conservative management may be viable depending on the clinical context and trimester.

Background: The effectiveness of glucocorticoids in preventing biphasic reactions in patients with anaphylaxis is still controversial. We evaluated the effects of glucocorticoids on rates of biphasic reactions in patients with anaphylaxis treated with adrenaline. Methods: In this retrospective observational study using a national inpatient database in Japan, we identified 31,570 patients with anaphylaxis treated with adrenaline on the day of admission. We divided them into two groups: those who were treated with adrenaline plus glucocorticoids and those who received adrenaline only on the day of admission. We performed a one-to-four propensity score matching analysis between the two groups. The primary outcome was occurrence of a biphasic reaction and the secondary outcome was 7-day all-cause mortality. Results: Of the 31,570 eligible patients, 28,145 (89.2%) were treated with glucocorticoids. After propensity score matching, there were no significant differences in rates of biphasic reactions (odds ratio, 1.03; 95% confidence interval, 0.86–1.24; p=0.14) or 7-day all-cause mortality (odds ratio, 0.68; 95% confidence interval, 0.40–1.17; p=0.16) between patients with anaphylaxis treated with and without glucocorticoids. Conclusion: Our findings do not support the use of glucocorticoids to prevent biphasic reactions in patients with severe anaphylaxis requiring adrenaline.

Abstract Objective: Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin Ⅲ (ATⅢ) for DIC in obstetrics; however, its effect remains uncertain. The present study therefore aimed to investigate the effect of ATⅢ for DIC patients in obstetrics, using a national inpatient database in Japan. Design: Nationwide observational study Setting: Japan Population: We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018. Methods: Propensity score matching analyses were performed to compare in-hospital maternal mortality and hysterectomy during hospitalization between users and non-users of ATⅢ on the day of delivery. Main Outcome Measures: In-hospital mortality, hysterectomy Results: A total of 9,920 patients were enrolled, including 4,329 patients (44%) who used ATⅢ and 5,511 patients (56%) who did not use ATⅢ. One-to-one propensity score matching created 3290 pairs. In-hospital maternal mortality did not differ significantly between the propensity-matched groups (0.3% in the ATⅢ group vs. 0.5% in the control group; odds ratio, 0.73; 95% confidence interval, 0.35–1.54). Patients in the ATⅢ group, compared with those in the control group, had a significantly lower proportion of receiving hysterectomy during hospitalization (5.3% vs. 8.7%; difference, -2.9%; 95% confidence interval, -4.2 to -1.6%). Conclusions: The present study did not show mortality-reducing effect of ATIII for patients with DIC in obstetrics. ATⅢ may have clinical benefit in terms of reduction in receiving hysterectomy.