Advertisement

Pregnancy and Appendicitis

  • Emily Smith
  • Jaimey M. PauliEmail author
Chapter

Abstract

Appendicitis is a frequent part of the differential diagnosis of right lower quadrant pain in pregnancy. The differential also includes cholecystitis, pancreatitis, gastroenteritis, right lower lobe pneumonia, ovarian torsion, uterine myoma degeneration, pyelonephritis, urinary tract infection, and round ligament pain. For evaluation of gynecologic etiologies and fetal well-being, depending on gestational age, an OBGYN consult is appropriate. Evaluation should include physical exam, vital sign review, and laboratory value review. Mild tachycardia and leukocytosis can be normal physiologic changes in pregnancy. Imaging should start with ultrasound and if inconclusive proceed to magnetic resonance imaging (MRI). Management if appendicitis if suspected is surgical. Surgical approach should be influenced by size of the gravid uterus, comfort with laparoscopic versus open surgery, and concern for appendiceal rupture. Patients should also be counseled about risk of preterm labor and fetal loss. Risk of fetal loss is highest in the setting of appendiceal rupture.

Keywords

Appendicitis Pregnancy Ultrasound MRI Appendectomy Fetal loss Right lower quadrant pain 

References

  1. 1.
    Mourad J, Elliott JP, Erickson L, et al. Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol. 2000;182:1027–9.CrossRefGoogle Scholar
  2. 2.
    Tracey M, Fletcher HS. Appendicitis in pregnancy. Am Surg. 2000;66:555–9.PubMedGoogle Scholar
  3. 3.
    Weingold AB. Appendicitis in pregnancy. Clin Obstet Gynecol. 1983;26:801–9.CrossRefGoogle Scholar
  4. 4.
    Al-Mulhim AA. Acute appendicitis in pregnancy: a review of 52 cases. Int Surg. 1996;81:295–7.PubMedGoogle Scholar
  5. 5.
    Williams R, Shaw J. Ultrasound scanning in the diagnosis of acute appendicitis in pregnancy. Emerg Med J. 2007;24:359–60.CrossRefGoogle Scholar
  6. 6.
    Kanal E, Borgstede JP, Barkovich AJ, et al. American College of Radiology White Paper on MR safety: 2004 update and revisions. AJR Am J Roentgenol. 2004;182:1111–4.CrossRefGoogle Scholar
  7. 7.
    Long SS, Long C, Lai H, et al. Imaging strategies for right lower quadrant pain in pregnancy. AJR Am J Roentgenol. 2011;196:4–12.CrossRefGoogle Scholar
  8. 8.
    De Franca NA, Ramos do Amorim M, Nobrega SV. Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras. 2015;61(2):170–7.CrossRefGoogle Scholar
  9. 9.
    Sharp HT. The acute abdomen during pregnancy. Clin Obstet Gynecol. 2002;45(2):405–13.CrossRefGoogle Scholar
  10. 10.
    Affleck DG, Handrahan DL, Egger MJ, et al. The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg. 1999;178:523–9.CrossRefGoogle Scholar
  11. 11.
    Friedman JD, Ramsey PS, Ramin KD, et al. Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol. 2002;99:512–3.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Maternal-Fetal Medicine, Department of Obstetrics and GynecologyMedical College of WisconsinMilwaukeeUSA
  2. 2.Maternal-Fetal Medicine, Department of Obstetrics and GynecologyPenn State Health Milton S. Hershey Medical CenterHersheyUSA

Personalised recommendations