Abstract

Objective: The aim of this study was to investigate the clinical presentation, management, and main outcomes of acute appendicitis in pregnancy; appendiceal perforation, preterm labor, fetal loss.

Patients and methods: The medical files of pregnant women attending the emergency unit of Sohag University Hospital during the period from January 1999 to November 2007 were retrospectively reviewed for personal data, signs and symptoms on presentation, duration of symptoms, length of time from admission to operation, histological diagnosis, complications including preterm labor and appendiceal rupture, maternal and fetal mortality.

Results: The incidence of appendicitis in pregnancy was one in 822 pregnancies; the frequency of appendicitis was higher in the second trimester. The preoperative diagnosis was correct in (71.43%) of cases. The most common presenting symptom was right lower quadrant pain (92.86%) followed by nausea and vomiting (53.57%). Body temperature and leukocytic count were not helpful in establishing the correct diagnosis. 2 patients (7.14%) aborted and 5 patients had preterm labor (17.86%). There were 4 fetal losses 2 in the first trimester, 2 in the second trimester. 3 of these were in patients with perforated appendices (1 in the first trimester, 2 in the second trimester). There was no maternal mortality in this series. Interval between symptom onset and operation was the only independent factor associated with perforation (p= 0.001, OR=1.15, 95% CI= 1.08-1.29). Advanced gestational age (p= 0.024, OR=1.132, 95% CI= 1.015-1.288), the Interval between symptom onset and operation (p= 0.008, OR=1.019, 95% CI= 1.006-1.043) and, presence of perforated appendix (p= 0.007, OR=1.008, 95% CI= 1.002-1.022) were the variables associated with preterm labor.

Conclusion: The most common presenting symptom was right lower quadrant pain in all trimesters of pregnancy. Temperature and leukocytic count are not clear indicators of acute appendicitis in pregnancy. Interval between symptom onset and operation was the only factor associated with the risk of perforation, while, advanced gestational age, Interval between symptom onset and operation and presence of perforated appendix were the variables associated with the risk of preterm labor.