Appendicitis In Pregnancy: What Are The Risks?

Appendicitis is not an ailment that occurs frequently in pregnancy. In fact, it is a condition that can arise at any time in a woman’s life. However, if appendicitis in pregnancy is not identified early, it can become severe.

In addition, it not only affects the mother, but threatens the well-being of the fetus. So the doctor will choose to perform an emergency surgery.

Identifying the condition will depend on the experience of the specialist, on the suspicion of the diagnosis, as well as on the evolution times of the clinical picture.

What is appendicitis?

Appendicitis is inflammation of the appendix, which is located in the area where the large intestine (cecum) begins. The main cause of this condition is the obstruction of a small duct known as the appendix lumen, as this article published in the Medical Journal of the Mexican Social Security Institute points out .

Causes rapid stretching of tissues due to tension. As a result, nerve fibers are stimulated and causes diffuse pain. Also, as the distension progresses, there could be a perforation in the area.

Perforation in the appendix is ​​the most important factor in relation to fetal and maternal death, since it causes the dispersion of the contents of the intestine in the abdominal cavity, which is known as peritonitis.

Classic symptoms of appendicitis

The symptoms of appendicitis in pregnancy are similar to those that a woman who is not pregnant could present.

It should be noted that due to normal changes in pregnancy, such symptoms may vary somewhat and may even become confusing for physicians. On the other hand, according to the MSD Manual,  “in older people and pregnant women, the pain may be less intense and the tenderness less” .

In general, the symptoms are the following:

• Fever.
• Spasms
• Leukocytosis.
• Nausea and vomiting.
• Constipation or diarrhea (depending on the case).
• Stiffness, pain and abdominal tenderness.
• Pain in the right iliac fossa ( right lower quadrant).

Complications of appendicitis during pregnancy

Treatment of appendicitis in pregnancy should be surgical and urgent, regardless of gestational age. However, there are very particular challenges for the surgeon due to the normal changes that pregnancy brings with it.

During pregnancy, the woman undergoes certain anatomical changes with respect to the position of some organs, including the appendix. In these cases, it is said that there is displacement of the internal organs. Likewise, there are other important modifications such as the uterus enlarging and abdominal palpation is difficult.

The aforementioned changes make diagnosis difficult. There are certain points of hypersensitivity, such as McBurney’s point, which change during pregnancy, making it difficult to correctly identify acute appendicitis.

In addition, there are other physiological changes that affect the interpretation of laboratory studies and physical examination. Include anemia, decreased heart rate or leukocytosis, among other conditions.

If the diagnosis is not made in time, it can lead to health complications such as the following:

• Abortion.
• Pylephlebitis.
• Fetal death.
• Diffuse peritonitis.
• Maternal death.
• Preterm delivery.
• Localized abscess.
• Generalized sepsis.
• Urinary infection a.
• Differential diagnosis.

Appendicitis: a difficult diagnosis

Added to the risks of appendicitis in pregnancy and its complications, is sometimes added the difficult diagnosis or its delay, as this article published in the Medical Journal of Costa Rica and Central America points out .

Specialists usually perform alternate studies that allow them to rule out diseases with similar symptoms. This procedure is known as differential diagnosis.

Among this group of conditions are urinary infections, stasis, twisted ovarian cysts, postural pain, early symptoms of miscarriage or labor, among other health problems.

The risks of appendicitis in pregnancy

The risk of appendicitis in pregnancy is directly dependent on early diagnosis and removal of the diseased appendix. If it is taken care of on time, the complications and dangers diminish of considerable way.

Appendicitis in pregnancy is serious for the mother. However, it is much more dangerous for the fetus ; Due to the perforation of the appendix, the baby may die hours later.

Statistics regarding the risk of appendicitis in pregnancy vary according to various investigations, as shown in the last article cited above. The percentage of premature births and abortions reaches 8.3% and 2.6% of the population studied. On the other hand, some authors defined maternal mortality as almost zero compared to a variable percentage between 0 and 11% for the fetus.

In summary, the risk of appendicitis worsens depending on the pregnant woman’s state of pregnancy, which can result in fetal complications and infection of the surgical site.

For that reason, early diagnosis allows both mother and baby to be treated in a timely manner with minimal complications and risks to both.