Appendicitis in pregnancy: how to manage and whether to deliver

Abstract

Key content Appendicitis in pregnancy is common. Whether to deliver a pregnant woman with appendicitis is a contentious issue. There are many uncertainties with diagnosis of appendicitis in pregnancy. Management of pregnant women with appendicitis requires a multidisciplinary approach involving obstetricians, anaesthetists and surgeons. Learning objectives To understand the modalities useful in accurate diagnosis of appendicitis in pregnancy. To learn about the range of clinical presentations and differential diagnoses. To appreciate the risks involved with different management options, anaesthetic and surgical. To be able to manage a pregnant woman with suspected appendicitis for the best possible outcome. Ethical issues Operative delivery of a pregnant woman with appendicitis may put her at unnecessary risk. How should she best be managed for the best possible outcome for her and the fetus?

Surgical causes of acute abdominal pain in pregnancy

“…In cases where the patient is critically ill – e.g. a perforated appendix – delivery of the baby increases the effectiveness of maternal resuscitation and improves recovery time . Postoperative venous thromboembolism prophylaxis must not be forgotten.…”

“…This may be conducted as an open or laparoscopic procedure, dependent on the severity of presentation, surgeon expertise and gestation. The severity of appendicitis dictates the degree of maternal and fetal morbidity . Appendicitis is a progressive disease, with early diagnosis and treatment preventing appendiceal perforation and localised or generalised peritonitis caused by purulent or faecal contamination.…”

“…For chronic appendicitis or appendiceal masses in the nonpregnant patient, conservative management with intravenous antibiotics and fluid resuscitation may be considered. Minimal data are available for this management option in pregnant patients …”

“…a perforated appendix -delivery of the baby increases the effectiveness of maternal resuscitation and improves recovery time. 24 Postoperative venous thromboembolism prophylaxis must not be forgotten. If there has been any manipulation of the uterus during surgery, anti-D serum should be given to Rhesus D-negative women if the fetal blood group is Rhesus D-positive or unknown.…”

“…The severity of appendicitis dictates the degree of maternal and fetal morbidity. 24 Appendicitis is a progressive disease, with early diagnosis and treatment preventing appendiceal perforation and localised or generalised peritonitis caused by purulent or faecal contamination. For chronic appendicitis or appendiceal masses in the nonpregnant patient, conservative management with intravenous antibiotics and fluid resuscitation may be considered.…”