Appendicitis In Pregnancy Symptoms: Appendicitis And Pregnancy

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Appendicitis is the most common extra-uterine emergency in pregnancy that requires instant surgical intervention. Check out the causes, symptoms and treatment of Appendicitis in Pregnancy.

Appendicitis is a relatively common phenomenon encountered during pregnancy. Appendicitis in pregnancy is the most common non-obstetric emergency that needs immediate surgical intervention. Pregnant women appear to be less probable to have appendicitis than age-matched. Appendicitis can occur at anytime, without prior warning. The incidence of appendicitis has been reported in 5 – 13% of pregnancies and should be treated promptly. The appendix is a small protrusion in the shape of a worm like pouch and is situated in the lower right area of the abdomen. Appendicitis in pregnancy after the 6th month of pregnancy could lead to premature labour in up to 1 in every 2 women with this condition.

Appendicitis In Pregnancy Symptoms: Appendicitis And Pregnancy

In this condition, the appendix is inflamed, swollen and infected, resulting in pain that originates from the centre of the abdomen and localizes in the lower right side of the abdomen. The functionality of appendix is unclear and so its removal does not seem to affect a person’s health in anyway. But, new studies are investigating the possibility that the appendix may contain and protect bacteria that are advantageous in the function of the human colon. For appendicitis, the most common form of treatment is surgery and elimination of the appendix.

Causes of Acute Appendicitis in Pregnancy:

An obstruction on the inside of the appendix (the appendiceal lumen) can cause appendicitis. It results in buildup of mucus and bacteria growth causes the appendix to become swollen and infected. If an inflamed appendix is not eliminated, then it will likely burst that leads to a dangerous condition called peritonitis where the puncture in the appendix causes pus to spill out of the colon and form large abscesses in the abdominal cavity. The condition can be fatal if not treated promptly.

An obstruction in appendix wall may be caused by feces, parasites or growths, enlarged lymph tissues, inflammatory bowel diseases including Crohn’s disease and ulcerative colitis or trauma to the abdomen.

Symptoms of Appendicitis in Pregnancy:

The danger is doubled when appendicitis takes place in pregnant women as two lives are at stake. So, it is very important to identify the symptoms of appendicitis and differentiate them from pregnancy sensations.

Early symptoms of appendicitis may take 4 to 48 hours to develop and include:

Dull pain around the belly button escalating into a sharp pain in the lower right abdomen
Constipation, diarrhea, or gas
Nausea and vomiting
Abdominal tenderness
Loss of appetite
Low grade fever (37 – 39 degrees)

Advanced symptoms of appendicitis may include:

Pain on the right side of the abdomen when pressed on the left side
Abdominal swelling and rigidity

Diagnosis of Appendicitis in Pregnancy:

In pregnant women, the diagnosis of appendicitis poses difficulties due to the altered state of the body caused by pregnancy. Features such as drowsiness, nausea, vomiting, dizziness and loss of appetite are also commonly experience during the normal course of pregnancy. Women may also experience pain because of false labor. Laboratory finding of elevated white blood cells in acute appendicitis also take place in normal pregnancy. As these symptoms are so similar to those experienced due to appendicitis, there is frequently a delay in diagnosing the condition correctly as appendicitis.

In pregnancy, the clinical manifestations and diagnostic evaluation of appendicitis are similar to those in non-pregnant individuals.

Certain points that apply to pregnant women:

The rate appendicitis is slightly higher in the second trimester than in the first and third trimesters or postpartum. Probably due to delay in diagnosis and intervention, an infected appendix appears to be more likely to rupture during pregnancy, especially in the third trimester.
The most common symptom of appendicitis is right lower quadrant pain and it should alert the physician caring for the pregnant patient to strongly consider this diagnosis. In pregnancy, the location of the appendix migrates a few centimeters cephalad due to the enlarging of uterus.

Differential diagnosis:

The differential diagnosis includes the causes of abdominal pain in non-pregnant individuals and also the pregnancy-related causes of abdominal pain, such as round ligament syndrome, labor, abruption, ectopic pregnancy, and uterine rupture. The latter three diagnoses in appendicitis are often escorted by uterine bleeding. Additionally, abruption and uterine rupture are commonly related with fetal heart rate abnormalities.

Treatment of Appendicitis in Pregnancy:

If appendicitis is suspected, then a gynaecologist or surgeon will order an immediate appendectomy to minimize the probability that the appendix will burst.

An appendectomy, surgical removal of appendicitis is performed early for best results. Appendicitis progresses in a few days only and so immediate treatment is vital. If rupture of the appendix take place, then it can be dangerous to mortality of the mother and her baby. Along with surgery, perioperative antibiotics can be vital to prevent the bursting of the appendix, and decrease the hazard.

A laparoscopic appendectomy or an open appendectomy may be carried out depending on what is best for the mother. A laparoscopic appendectomy removes the appendix through a single incision in the lower right abdomen while an open appendectomy uses several small incision and special surgical tools fed through the incision to eliminate the appendix.

Both these surgical procedures are considered equally safe. If conditions permit, then laparoscopic surgery has the benefit of lesser narcotic use, better intra-operative visualization, decreased postoperative pain, quick return of bowel function, early ambulation and a shorter stay in the hospital post surgery. But, it increases a few concerns, including raised intra-abdominal pressure and the use of carbon dioxide pneumoperitoneum.

Consequences:

If the inflamed appendix is not eliminated, then a returning cycle of inflammation could start; the abdominal lining could also become inflamed and an abscess could expand. The abscess is a pus-filled area of inflammation that signifies bacterial infection. Sepsis (poisoning from the infectious bacteria enters the bloodstream) could develop if the inflamed appendix is still not eliminated. Preterm delivery is uncommon and in some cases, threatened premature labor has been due to a ruptured appendix. In some cases, delay in operating has led to premature delivery. If any one of these health complications takes place, then pregnant women and her baby could also die.