Acute Appendicitis in Pregnancy

Purpose. Acute appendicitis is one of the most common non-obstetric emergencies during pregnancy and early appendectomy is the usual treatment of choice. Because accurate diagnosis in pregnant women is more challenging due to the combined obstetric symptoms, this study reviewed such cases. Methods. From October 1993 to July 2008,31 pregnant patients who underwent appendectomy for acute appendicitis at the National Taiwan University Hospital were identified. Data on their gestational age, symptoms, leukocyte count, abdominal sonography, pathologic diagnosis, and perioperative obstetric events were obtained through a retrospective chart review. Results. Of the 31 patients who underwent appendectomy, 25 had confirmed acute appendicitis by histopathology. The patients were divided into the negative appendectomy (NA) group (n=6) and the positive appendectomy (PA) group (n=25). The median leukocyte count was 14,970/mm^3 in the PA group and 11,695/mm^3 in the NA group (p=0.048). The symptom of right lower quadrant pain was 100% in the NA group (p=0.004). Abdominal sonography had 80% sensitivity and 75% specificity. Among the first, second and third trimesters, diagnostic accuracy was 88.9%, 73.3%, and 85.7%, respectively (average 80.6%). Ten patients were complicated by obstetric events, including fetal death (n=1) and artificial abortion (n=2). Obstetric events were more in the PA group. Conclusions. The diagnostic accuracy of acute appendicitis in pregnant women is comparable to that of the general population. Physical examination and history taking remain important. Early appendectomy prevents complicated conditions. There are more obstetric events in pregnant patients of true appendicitis.