DIAGNOSIS, MANAGEMENT AND CLINICOPATHOLOGICAL FEATURES OF ACUTE APPENDICITIS IN PREGNANT WOMEN AND ITS IMPACT ON FETAL OUTCOMES

Abstract

Objective: To evaluate the clinicopathological features and feto-maternal outcomes of appendicitis during pregnancy. Material and Method: This study involved comparisons of laboratory findings, preoperative ultrasonography (US), pathology and clinical outcomes of 17 pregnant and 59 age-matched non-pregnant women undergoing appendectomy. Results: The total number of US scans, rates of non-visualized appendix on US, and length of hospital stay were higher in pregnant women than in non-pregnant subjects (p < 0.001, p=0.035, and p=0.014; respectively). The rate of negative appendectomy was 1.5-times higher and the rate of complicated appendicitis was 7-times higher in pregnant compared with non-pregnant patients. The diagnostic accuracy of US was higher in the non-pregnant group (72.9% vs. 64.7%). In terms of the hematological parameters, no significant difference was found between the pregnant patients with and without appendicitis. There was one premature birth and one abortus in the second trimester, and one premature birth followed by a negative appendectomy in the third trimester. Conclusion: The diagnosis of acute appendicitis in pregnancy may remain inconclusive despite comprehensive evaluation with clinical examination, laboratory studies, and US. We recommend that clinicians consider additional imaging scans when they suspect appendicitis during pregnancy to avoid unnecessary surgical interventions. Both complicated appendicitis and negative appendectomy can cause a non-negligible rate of fetal morbidity and mortality.