APPENDICITIS
IN PREGNANCY: NEW INFORMATION THAT CONTRADICTS LONG-HELD CLINICAL BELIEFS.
Mourad
J, et al. Am J Obstet Gynecol 2000 May;182(5):1027-9
OBJECTIVE:
Our purpose was to elicit a better understanding of the presentation of acute
appendicitis in pregnancy and to clarify diagnostic dilemmas reported in the
literature.
STUDY DESIGN:
We retrospectively reviewed 66,993 consecutive deliveries from 1986 to 1995 by
a computer program. Selected records were reviewed for gestational age; signs
and symptoms at presentation; complications including preterm contractions,
preterm labor, and appendiceal rupture; and histologic diagnosis of
appendicitis.
RESULTS:
Of 66, 993 deliveries, 67 (0.1%) were complicated by a preoperative diagnosis
of probable appendicitis. Acute appendicitis was confirmed histologically in 45
(67%) of the 67 cases, for an incidence of 1 in 1493 pregnancies in this
population. Distribution of suspected appendicitis in pregnancy was as follows:
first trimester, 17 cases (25%); second trimester, 27 (40%); and third
trimester, 23 (34%). Right-lower-quadrant pain was the most common presenting
symptom regardless of gestational age (first trimester, 12 [86%] of 14 cases;
second trimester, 15 [83%] of 18 cases; and third trimester, 10 [78%] of 13
cases). The mean maximal temperature for proven appendicitis was 37.6 degrees C
(35.5 degrees C-39.4 degrees C), in comparison with 37.8 degrees C (36.7
degrees C-38.9 degrees C; not significant) for those with normal histologic
findings. The mean leukocyte count in patients with proven appendicitis was
16.4 x 10(9)/L (8.2-27.0 x 10(9)/L), in comparison with 14.0 x 10(9)/L (5.
9-25.0 x 10(9)/L) for patients with normal histologic findings. At the time of
surgery, perforation had occurred in 8 cases. Of 23 patients at > or =24
weeks' gestational age, 19 (83%) had contractions and an additional 3 patients
(13%) had preterm labor with documented cervical change. One patient was
delivered in the immediate postoperative period because of abruptio placentae.
CONCLUSION:
Pain in the right lower quadrant of the abdomen is the most common presenting
symptom of appendicitis in pregnancy regardless of gestational age. Fever and
leukocytosis are not clear indicators of appendicitis in pregnancy and preterm
labor is a problem after appendectomy, but preterm delivery is rare.