What to do if you have appendicitis during pregnancy

Since appendicitis is a relatively common disease, many people think that it should not be serious and will not cause much harm. In fact, this is not the case. Although appendicitis is common, it is very likely to have serious consequences. Severe appendicitis may even lead to death. People should pay attention to appendicitis, learn more about its symptoms, make a diagnosis as early as possible, and go to the hospital for diagnosis and treatment. Whether it is children or adults, appendicitis is not complicated to treat, but there is a special group that is not only difficult to diagnose but also more complicated to treat, and that is pregnant women. What should I do if I have appendicitis during pregnancy?

1. Clinical manifestations

Acute appendicitis is the most common surgical emergency abdomen during pregnancy, usually occurring in the 3rd to 6th month of pregnancy. The diagnosis of acute appendicitis in pregnant women is more difficult, especially in the second and third trimesters of pregnancy (i.e., March to September). This is mainly due to changes in the position of the appendix, which leads to atypical symptoms and even misdiagnosis.

2. Diagnosis

Ultrasound is an important diagnostic tool, especially during the first trimester of pregnancy. Its diagnostic value is reduced during the 6th to 9th month of pregnancy due to technical difficulties. The diagnostic accuracy of ultrasound depends largely on the operator's experience and therefore varies greatly, with sensitivity and specificity ranging from 50% to 100% and 33% to 92%, respectively. If ultrasound cannot clearly identify appendicitis (regardless of whether the appendix is ​​normal or not), then MRI should be used as a second diagnostic method (MRI has a sensitivity of 100% and a specificity of 94%). If MRI is not available or cannot be used, CT can be used as an alternative. The risk of undiagnosed appendicitis during pregnancy far outweighs the low and limited radiation risk of CT. The diagnostic accuracy of CT during pregnancy is similar to that of the normal population, with a sensitivity and specificity of 92% and 99%, respectively.

Treatment

Treatment of acute appendicitis in pregnant women is surgical removal of the appendix, and the management strategy depends on gestational age, severity of appendicitis, body mass index, history of previous abdominal surgery, and surgeon capabilities and preferences. Laparoscopic appendectomy is the standard first-line treatment for acute appendicitis in pregnant women, regardless of gestational age. If you choose to have an open appendectomy, you can choose the classic McBurney incision during the first three months of pregnancy. However, during the third to ninth months of pregnancy, the incision must be made at a higher position on the right side, and you can even choose a midline incision in the upper abdomen to better find the appendix. If there is extensive peritonitis, a midline incision centered on the umbilicus should be chosen to facilitate abdominal exploration and peritoneal lavage.