Acute Appendicitis during Pregnancy; Results of a Cohort Study in a Single Iranian Center

Abstract

Acute appendicitis during the pregnancy was associated with longer duration of symptoms, lower body temperature and higher rate of pneumonia. The pregnancy and neonatal outcomes were comparable to the previously reported data.

Non-obstetric surgery during pregnancy – an eleven-year retrospective analysis

“…In accordance with published studies, in our patient collective, acute appendicitis was the predominant reason for nonobstetric abdominal surgery during pregnancy [6,14]. Complicated forms of acute appendicitis are reported to be more frequent in pregnant women and are associated with obstetrical complications such as premature delivery [4][5][6]. In our total collective, there were 12 premature births (16%), of which only 4 (10%) occurred after open appendectomy (none of which was characterized as complicated).…”

“…According to American College of Radiology, it is less reliable in detecting the presence of extraluminal air in perforated intestine, and therefore placed as second line imaging diagnostic method in this case [15]. In accordance with published studies, in our patient collective, acute appendicitis was the predominant reason for nonobstetric abdominal surgery during pregnancy [6,14]. Complicated forms of acute appendicitis are reported to be more frequent in pregnant women and are associated with obstetrical complications such as premature delivery [4][5][6].…”

“…Non-obstetric acute abdomen during pregnancy can be a diagnostic and therapeutic challenge. Pregnancy can obscure the clinical diagnosis; the perfomance of clinical examinations is still controversial [6], and the debate on the safest surgical approach during pregnancy continues. The diagnosis of acute appendicitis is based mainly on the history and physical examination, which is less reliable in pregnant women, who undergo pathophysiological changes that favor relative immune suppression, thus altering the inflammatory response [4,5,9, 14,15,16,].…”

“…The most frequent indications for surgery during pregnancy are infections such as acute appendicitis and cholecystitis [5][6][7][8][9][10][11][12][13][14]; pregnant women may also require acute surgical intervention for ovarian disorders and bowel obstruction, as well as for traumatological or oncological indications [11]. Any kind of pathology can occur in pregnant women and require immediate surgical treatment and optimized interdisciplinary management to achieve maximum safety for both mother and fetus, to avoid teratogenous medication, fetal acidosis and hypoxemia, and adverse pregnancy outcomes such as miscarriage, stillbirth or premature birth [4,8].…”

Acute Appendicitis in Pregnancy: How to Manage?

“…The growth of uterus, by pushing the appendix, may cause a deviation in its normal axis. [ 2 , 4 , 7 , 12 , 13 ] The distance between the appendix and anterior abdominal wall grows bigger ending up with a reduction in abdominal wall sensitivity and defense. [ 4 , 7 ] Thus, it becomes challenging to make the diagnosis over the symptoms and clinical picture in pregnant patients.…”