Appendicitis occurs in about 1 of 1500 pregnancies. The diagnosis is more difficult to make clinically in pregnant women where the appendix is displaced cephalad from McBurney point. Furthermore, nausea, vomiting, and mild leukocytosis occur in normal pregnancy, so with or without these findings, any complaint of right-sided pain should raise suspicion. Imaging can help confirm the diagnosis if clinical findings are equivocal. Abdominal sonography is a reasonable initial imaging choice, but nonvisualization of the appendix is common in pregnancy. CT scanning is more sensitive than ultrasound, and with proper shielding, the radiation exposure to the fetus is minimized. MRI is also used to evaluate for appendicitis in pregnant women and is a reasonable alternative to CT scanning.
An operative approach to appendicitis, rather than a conservative nonoperative approach, is indicated for pregnant patients. Conservative management is associated with increases in maternal morbidity, including septic shock, peritonitis, and venous thromboembolism.
Unfortunately, the diagnosis of appendicitis is not made until the appendix has ruptured in at least 20% of obstetric patients. Peritonitis in these cases can lead to preterm labor or abortion. With early diagnosis and appendectomy, the prognosis is good for mother and baby.
et al. Outcomes after open and laparoscopic appendectomy during pregnancy: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;225:40.
et al. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol. 2020;63:405.