Acute appendicitis in pregnancy; maternal and foetal outcome

ABSTRACT

To determine the maternal and foetal outcome among the cases of acute appendicitis during pregnancy. Prospective Study. Aga Khan Hospital for Women, Kutyana Memon Hospital and Hamdard University Hospital, where authors work. Period From June 2004 to May 2008. A total of 21 pregnant females who presented with right sided abdominal pain with clinical diagnosis of acute appendicitis were managed during this study period. All patients were admitted and managed by both surgeon and obstetrician. Detailed 'clinical history and physical examination was performed and all patients were investigated by complete blood picture, urine analysis and ultrasonography of abdomen and pelvis. Appendicectomy was performed through Grid Iron incision. Macroscopic appearance of appendices and other operative findings were recorded and all specimens were sent for histopathology. All the patients were followed up till the out come of pregnancy. Twenty one patients were managed during this study period and out of these 21,13 patients were primigravida and 8 were multigravida. At presentation most of the patients were in their second trimester of pregnancy. Acute appendicitis was confirmed by histopathologically in 16 out of 17 patients with inflamed looking appendices [negative appendicectomy rate was 23.80%]. Foetal loss occurred in 2 patients [9.52%] and both were in their second trimester of pregnancy. One patient gave birth to a baby who had low birth weight [4.76%] and one patient who was operated in third trimester had premature labour [4.76%] three weeks prior to expected date. Remaining 17 patients delivered at term without any consequences. Two patients developed wound infection which responded to wound care and antibiotics. Acute appendicitis is the commonest cause of acute abdomen during pregnancy. A timely decision and a professional liaison among obstetrician and surgeon are key factors for a better outcome: