From the Guidelines
Pregnancy increases the risk of complicated acute appendicitis, and early diagnosis and treatment are crucial to prevent fetal loss and other complications.
Relationship between Pregnancy and Acute Appendicitis
The relationship between pregnancy and acute appendicitis is complex, with pregnancy being a significant risk factor for complicated appendicitis, including perforation and gangrene 1.
- Incidence of Appendicitis in Pregnancy: Appendicitis is one of the most common non-obstetric surgical conditions in pregnant women, with a higher incidence of complicated appendicitis compared to non-pregnant women 1.
- Clinical Presentation: Pregnant women with appendicitis may present with similar symptoms to non-pregnant women, including right lower quadrant pain, fever, and leukocytosis 1.
- Imaging Modalities: Ultrasound (US) and magnetic resonance imaging (MRI) are commonly used imaging modalities for diagnosing appendicitis in pregnant women, with MRI being more sensitive and specific than US 1.
- Diagnostic Performance of US and MRI: The diagnostic performance of US and MRI in pregnant women with suspected appendicitis varies, with US having a lower sensitivity and specificity compared to MRI 1.
- Recommendations: The American College of Radiology (ACR) recommends the use of US as the initial imaging modality for suspected appendicitis in pregnant women, with MRI being used as a secondary modality if US is inconclusive or if there is a high clinical suspicion of appendicitis 1.
- Importance of Early Diagnosis and Treatment: Early diagnosis and treatment of appendicitis in pregnant women are crucial to prevent fetal loss and other complications, including perforation and gangrene 1.
From the Research
Relationship Between Pregnancy and Acute Appendicitis
The relationship between pregnancy and acute appendicitis is complex, with various studies indicating that pregnancy can affect the diagnosis, management, and outcomes of acute appendicitis.
- Acute appendicitis is the most common nonobstetric surgical diagnosis in pregnancy, with an incidence of 0.05-0.07% 2, 3.
- The physiologic and anatomic changes in pregnancy can obscure and delay the diagnosis of acute appendicitis, contributing to its increased risk in pregnancy 2.
- Studies have shown that the clinical presentation and outcome of presumed acute appendicitis are similar in pregnant women and nonpregnant women of reproductive age 3.
- However, pregnancy-related limiting factors may complicate the diagnosis of acute appendicitis, and these patients may need a more skeptical assessment and additional diagnostic tools beyond the standard clinical approach 4.
Diagnostic Challenges
- The diagnosis of acute appendicitis during pregnancy can be challenging due to the similarity of symptoms with pregnancy-related pathologies 5, 6.
- Imaging studies, such as ultrasound and MRI, can be useful in diagnosing acute appendicitis during pregnancy, but their use may be limited by pregnancy-related factors 6, 4.
- The use of preoperative abdominal ultrasound is higher in pregnant patients than in nonpregnant patients, while the use of computed tomography is lower 3.
Management and Outcomes
- The management of acute appendicitis during pregnancy involves surgical intervention, with the goal of reducing the risk of maternal and fetal complications 2, 3, 5, 6, 4.
- Laparoscopic appendectomy appears to be a safe option in the treatment of acute appendicitis during pregnancy, but its relationship with a higher risk of fetal loss should be kept in mind 4.
- The outcomes of acute appendicitis during pregnancy can be affected by various factors, including the timing of diagnosis and treatment, the presence of perforation, and the gestational age at diagnosis 2, 3, 5, 6, 4.
- Studies have shown that delay in the diagnosis and surgery of acute appendicitis during pregnancy may increase the risk of perinatal mortality and should not be delayed in diagnosis and surgery in pregnancy 5, 6.