Acute appendicitis during pregnancy: differences in clinical presentation, management, and outcome

Area of Science:

• Obstetrics and Gynecology
• Surgical Gastroenterology
• Emergency Medicine

Background:

• Acute appendicitis (AA) diagnosis in pregnant women is challenging due to atypical presentations.
• Pregnancy can alter the typical signs and symptoms of AA, complicating early detection.

Purpose of the Study:

• To compare the clinical presentation, management, and outcomes of acute appendicitis in pregnant versus nonpregnant women of childbearing age.
• To identify specific risks and outcomes associated with AA during different stages of pregnancy.

Main Methods:

• A descriptive study comparing two matched cohorts: pregnant (P) and nonpregnant (NP) women undergoing emergency appendectomy for suspected AA.
• Data collected included demographics, medical history, clinical presentation, management, and outcomes, with pregnant women categorized by trimester.

Main Results:

• A higher incidence of complicated AA (19.6% vs. 2.9%) and surgical wound infections (14.0% vs. 3.0%) was observed in pregnant women.
• Pregnant women experienced significantly longer hospital stays (mean 5.1 vs. 1.7 days).
• Outcomes were poorer in the third trimester, with increased risks of complications, infection, and prolonged hospitalization.

Conclusions:

• The atypical presentation of AA during pregnancy complicates diagnosis, increasing the likelihood of complications and adverse outcomes.
• Management of AA in pregnant individuals requires careful consideration, with outcomes worsening in later pregnancy stages.
• Increased vigilance and potentially modified diagnostic approaches are warranted for AA in pregnant women, particularly in the third trimester.