Acute appendicitis in the pregnant patient

Area of Science:

• Obstetrics and Gynecology
• Surgical Gastroenterology
• Maternal-Fetal Medicine

Background:

• Acute appendicitis is the most frequent surgical emergency during pregnancy.
• Diagnosis can be complicated by gestational physiological changes.
• Effective management strategies are essential for maternal and fetal well-being.

Purpose of the Study:

• To define the contemporary patient profile of acute appendicitis in pregnancy.
• To evaluate management strategies and outcomes.
• To identify factors influencing appendicitis diagnosis and complications.

Main Methods:

• Retrospective review of 84 pregnant patients undergoing laparotomy for suspected acute appendicitis.
• Analysis of gestational stage, presenting symptoms, laboratory results, and operative findings.
• Comparison of outcomes between positive and negative appendicitis diagnoses and across trimesters.

Main Results:

• 64% of patients had pathologically confirmed acute appendicitis, with incidence unaffected by trimester.
• Diagnostic challenges were noted, with no significant differences in symptoms or labs between positive and negative laparotomies.
• Perforation occurred in 43% of appendicitis cases, predominantly with symptom onset >24 hours.
• Negative laparotomies were associated with perinatal deaths/morbidity; prompt surgery prevented maternal mortality.

Conclusions:

• Physiological changes of pregnancy obscure appendicitis diagnosis.
• Appendicitis progression is not influenced by gestational trimester.
• Timely surgical exploration and preventing perforation are key to avoiding adverse outcomes in pregnant patients with appendicitis.