APPENDICITIS IN PREGNANCY
Appendicitis in pregnancy is a relatively common phenomenon. Rates of between 1 in every 1000 to 1 in 2000 pregnancy have been reported. Pregnant mothers thus do develop appendicitis too. Not uncommonly, attending physicians and patients develop a lot of anxiety about the occurrence of appendicitis during pregnancy and as to what is the best way to manage this condition.
A high index of suspicion, prompt diagnosis and surgical removal of the appendix even despite pregnancy is the appropriate management of appendicitis in the pregnant. Undiagnosed appendicitis in pregnancy is a potentially fatal surgical emergency. Up to 4 in 100 women with ruptured appendicitis in pregnancy will die, and 1 in 3 babies may be lost due to delay in diagnosis and treatment of appendicitis during pregnancy. After the 6th month of pregnancy, appendicitis during pregnancy could lead to premature labour in up to 1 in every 2 women with this condition.
Features such as nausea and vomiting may be thought to be those normally seen with pregnancy, and abdominal pain may be thought to be due to false labour or Braxton Hicks contractions . Even laboratory findings of elevated white blood cells in acute appendicitis occurs in normal pregnancy. Diagnosis in early pregnancy is not much of a problem as the signs and symptoms of appendicitis here is same in the non-pregnant woman. As the uterus gets bigger, it pushes the appendix upwards towards the right kidney. This causes the pain expected down in the lower right abdomen to be in the flank or even on the back. Thus the patient may be suspected of having right kidney infection, instead of appendicitis. Any pregnant woman with pain on the right side of the abdomen should therefore be scanned for a possible appendicitis. Frequently, urinary tract infection which is also common in pregnancy could actually occur alone or in co-existence with appendicitis in pregnancy. Undiagnosed appendicitis in pregnancy could lead to dire consequences. Up to 1 in 3 cases (30%) of ruptured undiagnosed appendicitis lead to loss and death of the baby.
Once there is suspicion of appendicitis, aggressive evaluation of the possibility is instituted, and operation advised, as may be deemed fit by the attending gynaecologist and surgeon. The current believe is that it is better for a normal appendix to be removed during an operation for suspected appendicitis in pregnancy than to allow complications occur because of not operating. It is considered acceptable, that up to one in three (up to 35%) expectant mothers who undergo surgical operation for appendicitis may turn out to have a normal appendix. Why this figure is quite high compared to what is acceptable in the normal population (15% in the non-pregnant population), the grave consequences of delayed surgery is not an option (Mostafa et al 2006). The most popular study done in this regard was by Horowitz and his colleagues. They reported an unfortunate outcome which occurred due to delays in surgical intervention once the diagnosis of appendicitis in pregnancy in 12 women was made. Surgery was delayed in 7 of these pregnant women with appendicitis for 24 hours. The result: 6 of the 7 women developed ruptured appendix within just 24 hours, leading to the death of two of the babies, the death of one of the mothers, and one premature delivery! What a tragic loss of 3 lives from unnecessary delay in operating a pregnant woman with appendicitis (Horowitz et al, 1985 - see the reference quoted below for full details). Outcome is usually good where perforation has not occurred. Some women could go into premature labour. To buttress this fact, is a study conducted by S. Mahmoodian in 1992. He reviewed 713 women in whom a diagnosis of appendicitis during pregnancy was made. A quarter of these patients had ruptured appendicitis. 5 of the mothers died as a result of the ruptured appendicitis. With surgery, he demonstrated that there is about 20 in 100 chance of death during operation in a woman with perforated or ruptured appendicitis in pregnancy, compared with only 4 in a 100 chances of death in un-perforated or non-ruptured appendicitis in pregnancy. The verdict: prompt surgical operation in women suspected to have appendicitis during pregnancy is key to saving both mother and baby. With dramatic improvements in medical technology over the last 10 years, surgical operations are even much more safer in both groups, especially with laparoscopic or keyhole surgery. Where pregnancy is still at the early stage, some have given progesterone or isoxuprine to protect and preserve the pregnancy. There should be minimal handling of the uterus during the operation. So, if you are pregnant and have signs and symptoms of appendicitis, go to your doctor immediately who would attempt to verify if you are having appendicitis in pregnancy. Once confirmed, having an operation to remove the diseased appendix is a wise thing to do if that is what your doctor also advices.
By Gamal Mostafa, Lamont Cathey, Frederick L. Greene Edition: illustrated Published by Springer, 2006 ISBN 038729080X, 9780387290805 page 398 HomeAdhesionsAbdominal Aortic Aneurysm Abdominal Migraine Abdominal Pain Store Appendicitis in Pregnancy Biliary Colic Braxton Hicks Carcinoid Tumour Chance Fracture Cholecystitis Constipation Crohn's Disease Donations ERCP Gastric Volvulus Gastroenteritis Gonorrhoea Heartburn Heiner Syndrome Indigestion & Heart Attack Irritable Bowel Syndrome (IBS) Menstrual Pain Messenteric Lymphadenitis Mid - Cycle Pain Non Specific Abdominal Pain Pancreatitis Pelvic Inflammatory Disease (PID) Peppermint Oil Period Pain PMS Rectus Sheet haematoma Recurrent Abdominal Pain Syndrome Trapped Wind VolvulusWhat Is Cancer
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