Appendicitis in pregnancy

Q: 28 years old female who is 32 weeks pregnant is admitted to ICU with acute appendicitis. Cesarean delivery should be carried out with appendectomy?

A) True

B) False

Answer: B

Pregnant patients with acute appendicitis are treated more or less as in normal population. Pharmacy should be consulted if antibiotics are prescribed to avoid fetal toxicity. Appendectomy is curative in pregnancy. Relying solely on on antibiotic treatment is not appropriate.

Delaying surgery carries a high risk of perforation. Cesarean delivery (C-section) is rarely required. Risk of dehiscence or uterine perforation later in vaginal delivery is low if fascia is closed properly.

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References:

1. Mazze RI, Källén B. Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 1991; 77:835. 

2. Joo JI, Park HC, Kim MJ, Lee BH. Outcomes of Antibiotic Therapy for Uncomplicated Appendicitis in Pregnancy. Am J Med 2017; 130:1467. 

3. Silvestri MT, Pettker CM, Brousseau EC, et al. Morbidity of appendectomy and cholecystectomy in pregnant and nonpregnant women. Obstet Gynecol 2011; 118:1261. 

4.  McGory ML, Zingmond DS, Tillou A, et al. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007; 205:534. Ito K, Ito H, Whang EE, 

5. Tavakkolizadeh A. Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 2012; 203:145.