Acute abdomen in pregnancy.

OBJECTIVE: To calculate the frequency of acute abdomen in pregnancy due to non-obstetric causes in a Saudi population, to discuss the etiology of the high incidence, to discuss how pregnancy altered the symptomatology of acute abdomen and to evaluate the result of early surgical intervention and use of tocolytics on maternal and fetal health. DESIGN: Retrospective analytic study of all cases of acute abdomen in pregnancy admitted between 1/1/1991 and 31/12/1993 to evaluate the result of early surgical intervention and use of tocolytics. SETTING: The surgical wards of Asir Central Hospital, Abha, Saudi Arabia. SUBJECTS: Sixty pregnant Saudi females who were admitted because of acute abdomen due to non-obstetric causes. RESULTS: The frequency of acute abdomen in pregnancy due to non-obstetric causes in this population is 0.39% which is high in comparison to other studies and the etiology is multifactorial. Resemblance of early acute abdomen symptoms like nausea, vomiting to those of normal pregnancy and the anatomical displacement of abdominal organs by the pregnant uterus greatly masked the clinical picture and enhanced surgical delay awaiting definitive criteria for surgical intervention. This delay significantly increased maternal morbidity (P < 0.05) and resulted in a poor fetal outcome. Those who had early surgical intervention had a better perinatal outcome (P < 0.001) and decreased maternal morbidity (P < 0.05). Although tocolytics were used, they proved to be ineffective, altered the maternal clinical picture and had fetal side-effects. CONCLUSION: There is a higher incidence of acute abdomen in pregnancy and although pregnancy blunted the clinical picture, early surgical intervention resulted in a better perinatal outcome and decreased maternal morbidity. Tocolytics had their side effects and did not improve the fetal outcome.

Is surgical intervention in acute cholecystitis in pregnancy justified?

Over a three-year period 49 cases were admitted to our hospital with an acute abdomen in pregnancy due to cholecystitis. In this article we compare surgical treatment with medical treatment and consider the aetiology of the high prevalence. Out of the 49 cases admitted, 15 cases (31%) had emergency cholecystectomy within the first week and 34 cases (69%) were treated conservatively of whom 24 relapsed many times and had to be readmitted to the hospital (mean number of admissions was 4 +/- 1.4 and the mean hospital stay was 8 +/- 2.3 days) and of the remaining 10 on conservative management, three had emergency cholecystectomy and seven reached term safely. The maternal morbidity is significantly less in the surgically treated group (P < 0.0001) but the perinatal outcome failed to show any significant difference. The frequency of acute cholecystitis in pregnancy (0.33%) is high in comparison with other studies. Although tocolytics were used in 13 cases they did not improve the fetal outcome significantly and had maternal and fetal side effects. In conclusion early surgical intervention is recommended and the use of tocolytics did not improve the perinatal outcome.