What is the risk of appendicitis (inflammation of the appendix) during pregnancy?

From the Guidelines

Appendicitis during pregnancy is a significant risk, with pregnant women being more likely to present with complicated appendicitis, which can lead to higher risk of fetal loss if not diagnosed and treated early.

Risk of Appendicitis in Pregnancy

• The risk of appendicitis in pregnant women is notable, with studies suggesting that it is one of the most common nonobstetric surgical conditions in pregnant women 1.
• Pregnant women with appendicitis are more likely to undergo nonsurgical management, but they are also more likely to present with complicated (perforated or gangrenous) appendicitis, which can increase the risk of fetal loss 1.

Diagnostic Imaging for Appendicitis in Pregnancy

• The use of imaging modalities such as ultrasound (US) and magnetic resonance imaging (MRI) is crucial in the diagnosis and management of suspected appendicitis in pregnant women 1.
• The Infectious Diseases Society of America recommends obtaining an abdominal US as the initial imaging modality to diagnose acute appendicitis in pregnant people, with a conditional recommendation and very low certainty of evidence 1.
• MRI can also be used as an initial imaging modality if access is readily available, and it may be particularly useful in cases where US results are equivocal 1.

Key Considerations

• Early diagnosis and treatment of appendicitis in pregnant women are essential to prevent complications and reduce the risk of fetal loss 1.
• Imaging modalities such as US and MRI play a critical role in the diagnosis and management of suspected appendicitis in pregnant women, and their use should be guided by clinical judgment and availability of resources 1.

From the Research

Risk of Appendicitis during Pregnancy

The risk of appendicitis during pregnancy is a significant concern, with several studies investigating its incidence and outcomes.

• The incidence of appendicitis in pregnancy has been reported to be around 0.05-0.07% 2, 0.1% 3, and 1 in 766 births 4.
• Appendicitis can occur at any stage of pregnancy, with some studies suggesting a higher incidence in the second trimester 3, 5.
• The clinical presentation of appendicitis in pregnancy can be similar to that in non-pregnant women, with abdominal pain being a common symptom 3, 4, 5.

Diagnosis and Management

Diagnosing appendicitis during pregnancy can be challenging due to the similarity of symptoms with other conditions.

• Imaging studies, such as ultrasound and MRI, can be useful in diagnosing appendicitis in pregnancy 6, 5.
• The treatment of appendicitis during pregnancy typically involves appendectomy by laparotomy, although the feasibility of video-assisted surgery is still debated 5.
• Prompt diagnosis and treatment are crucial to avoid complications, such as perforation and premature delivery 2, 3, 6.

Complications and Outcomes

The complications and outcomes of appendicitis during pregnancy can be significant.

• Perforation of the appendix can occur in up to 55% of cases 2.
• Premature delivery can occur in up to 14% of cases, particularly in the second trimester 4.
• Fetal loss can also occur, particularly in the first and second trimesters 4.
• Maternal morbidity can occur, although it is relatively rare 6.