Acute appendicitis during pregnancy is a severe and potentially life-threatening medical emergency and requires speedy medical attention. Despite pregnancy being a common cause of acute abdominal pain, it poses a unique diagnostic challenge, primarily because of the overlap of normal pregnancy symptoms and appendicitis signs.
Furthermore, the possibility of encountering complications is elevated due to the physiological changes happening in the body of a pregnant woman.
1. What Is Appendicitis?
Appendicitis occurs when the appendix is inflamed. This inflammation is often due to a blockage in the appendix lining, resulting in infection. Common symptoms include severe abdominal pain, particularly on the right side, nausea, vomiting, and fever. While anyone can develop appendicitis, it is most prevalent in people between 10 and 20.
2. Symptoms Of Appendicitis In Pregnancy
The presentation of acute appendicitis in pregnant women differs greatly from non-pregnant patients. The abdomen’s growing size and shifting organs can make it challenging to identify the exact location of the pain. Here are some unique symptoms to watch for:
Relocated Pain
The abdominal pain, which typically starts near the belly button and then gradually moves to the lower right side, might relocate upward as the uterus enlarges, especially in the second and third trimesters.
Elevated White Blood Cell Count
A complete blood count might reveal an elevated white blood cell count, signalling infection. However, this may also increase in a normal pregnancy, complicating the diagnosis.
Urinary Symptoms
Some pregnant patients may experience urinary tract infections that mimic appendicitis symptoms, such as frequent urination and abdominal discomfort.
Gastrointestinal Symptoms
Loss of appetite, vomiting, and nausea are all common symptoms of appendicitis. However, these symptoms also overlap with those of a normal pregnancy, which can add to the difficulty of diagnosing acute appendicitis during pregnancy.
Fever
A low-grade fever may be present in cases of acute appendicitis. If the fever is high, it may indicate a ruptured appendix, a severe complication.
Changes In Bowel Movements
Constipation or, in some cases, diarrhoea can occur. However, it’s worth noting these symptoms are not exclusive to appendicitis and can also be associated with normal pregnancy changes or other conditions.
Rebound Tenderness
This is a clinical sign often checked during a physical examination. It occurs when pain increases after pressure is quickly released from the abdomen, suggesting irritation to the peritoneum.
3. Diagnosing Appendicitis During Pregnancy
Acute appendicitis diagnosis in pregnant patients often presents a challenge due to the similarity of its symptoms with other conditions, such as ectopic pregnancy or inflammatory bowel disease. Nonetheless, healthcare providers typically utilise a multi-faceted approach, ensuring a correct diagnosis and avoiding invasive and unnecessary surgery. The diagnostic process may include:
- Clinical Signs: The medical professional will carefully consider the symptoms presented by the pregnant woman. These may include abdominal pain, relocated pain due to the growing uterus, and gastrointestinal symptoms.
- Physical Examination: This involves a detailed examination focusing on the abdominal area. The doctor might apply gentle pressure to the painful area, checking for rebound tenderness, a common sign of appendicitis.
- Laboratory Tests: Blood tests will be conducted, including a complete blood count. An elevated white blood cell count often indicates an infection in the body. However, as mentioned, this sign can be misleading as white blood cell count might also increase during normal pregnancy.
- Imaging Studies: Medical imaging techniques like ultrasound or magnetic resource imaging (MRI) are often used. These tests can help visualise the appendix and determine if there’s inflammation. Ultrasound is typically the first choice due to its safety profile for pregnant women and their unborn children.
It’s worth mentioning that these diagnostic methods aim not just to identify appendicitis but also to rule out other conditions that mimic it. The process requires careful consideration due to the implications of missed diagnosis and the potential negative impact of a surgical intervention when it’s not needed (negative appendectomy).
4. How To Treat Appendicitis In Pregnant Women
Once diagnosed with suspected acute appendicitis, surgical intervention is generally recommended. This is due to the high risk of a ruptured appendix, which could be life-threatening for both the mother and the unborn child.
Laparoscopic Appendectomy
A laparoscopic appendectomy is a minimally invasive surgical procedure preferred in the first and second trimesters. However, an open appendectomy may be necessary as the pregnancy progresses to the third trimester due to the enlarged uterus.
Open Appendectomy
This is a traditional surgical procedure typically performed when appendicitis is diagnosed in the third trimester of pregnancy. The procedure involves creating a larger incision in the abdominal area to remove the inflamed appendix.
As the uterus enlarges during the later stages of pregnancy, the appendix’s location may change, making it harder to reach with laparoscopic instruments. Therefore, open appendectomy offers better visibility and accessibility to the surgical site, allowing the surgeon to avoid contact with the uterus and other organs carefully.
Despite being more invasive than laparoscopic surgery, open appendectomy is considered safe for both mother and foetus during the late stages of pregnancy. However, it may have a slightly more extended recovery period and a higher chance of postoperative pain and complications like wound infection.
Antibiotic Therapy
After the surgical removal of the appendix, whether through laparoscopic or open surgery, antibiotic therapy is usually administered. This is a preventive measure to ward off potential infections resulting from the operation. The choice of antibiotics is critical here because some antibiotics are unsafe for pregnant women and can harm the unborn child.
Typically, a broad spectrum of pregnancy-safe antibiotics is prescribed. The length of the antibiotic course can vary depending on the patient’s overall health, any complications like peritonitis, and whether or not the appendix had ruptured before removal. The patient must complete the course of antibiotics as prescribed, even if they’re feeling better, to ensure the infection is fully eradicated and prevent antibiotic resistance.
Given the potential risks associated with a negative appendectomy, where a normal appendix is removed, precise diagnosis and careful treatment planning are crucial to ensure an ideal outcome for both the mother and the unborn child.
5. What Happens If You Get Appendicitis While Pregnant?
Acute appendicitis, if not treated promptly, can have severe implications for both mother and child. These risks include preterm labour, foetal loss, and in extreme cases, maternal death. Therefore, timely diagnosis and treatment of suspected appendicitis are crucial.
Should these symptoms arise, immediate consultation with a gastroenterologist or an obstetrician specialising in high-risk pregnancies is recommended. These specialists are well-versed in diagnosing and managing conditions like appendicitis during pregnancy, thus ensuring the best possible care and outcomes.
6. Preventing Appendicitis During Pregnancy
While there are no foolproof methods to prevent appendicitis during pregnancy, lifestyle choices may contribute to overall health and potentially decrease the chances of developing conditions like appendicitis. Some of these include:
- Balanced Diet: A diet rich in whole foods like leafy greens, fruits, protein, and whole grains can contribute to overall health. Some studies suggest that a high-fibre diet might reduce the likelihood of developing appendicitis, although more research is needed.
- Adequate Hydration: Drinking enough water daily helps the digestive system function smoothly and can prevent blockages in the appendix.
- Regular Exercise: Regular, moderate-intensity exercise, like walking or prenatal yoga, can enhance overall health and well-being. Exercise promotes better circulation and digestion, potentially reducing the risk of constipation – a condition sometimes associated with appendicitis.
- Routine Health Checkups: Regular checkups with your healthcare provider can help detect potential health issues early, including appendicitis-related problems.
- Prompt Attention To Health Concerns: If you notice changes in your health or unusual symptoms, don’t ignore them. Get early detection from a licensed healthcare professional to ensure you get an accurate diagnosis.
Conclusion About Appendicitis In Pregnancy
The diagnosis of acute appendicitis during pregnancy is challenging for clinicians. This is because the symptoms of appendicitis often overlap with other conditions. Immediately recognising its symptoms and treatment is vital to prevent severe consequences for mother and child.
Additionally, understanding the symptoms of appendicitis, how it’s diagnosed, and available treatment options can better prepare pregnant women should they find themselves in this situation.
If you spot the common signs of appendicitis while you’re pregnant, consider consulting with a professional colorectal specialist in Singapore like Dr Leong.
Frequently Asked Questions On Appendicitis When Pregnant
Is It Safe To Have Appendix Surgery When Pregnant?
Yes, it is generally safe to have appendix surgery during pregnancy. Both laparoscopic and open appendectomy are considered safe surgical interventions for pregnant women with appendicitis.
Can Appendicitis Cause A Miscarriage?
While appendicitis itself does not typically cause miscarriage, complications from untreated or severe appendicitis, such as infection or rupture, could potentially lead to miscarriage or preterm labour.
Why Does My Right Side Hurt During Pregnancy?
Right-side pain during pregnancy could be due to several reasons, including regular pregnancy changes, round ligament pain, or conditions like appendicitis or gallbladder disease.
Where Is The Appendix Located When Pregnant?
When the uterus expands, pregnancy can shift the appendix upwards. Its exact location can vary, making diagnosis difficult.
Can Appendicitis Feel Like Pregnancy Pain?
Yes, some symptoms of appendicitis, such as abdominal discomfort and nausea, can overlap with those of normal pregnancy, making diagnosis challenging.
Does Removal Of Appendix Affect Pregnancy?
No conclusive evidence suggests that removing the appendix negatively impacts future pregnancies. However, like any surgery, it does carry with it certain risks of complications.
