Acute Appendicitis During Pregnancy at Maharat Nakhon Ratchasima Hospital

Abstract

          Background: Acute appendicitis is the most non-obstetric surgical emergency during pregnancy, requiring continue to obscure to accurate diagnosis of acute appendicitis. Delay treatment increases incidence of maternal and fetal morbidity and mortality. Few studies explained about incidence, clinical presentation, diagnostic ultrasonography, preterm labor and tocolytic drugs of this condition. Objective: To determine incidence and examine clinical features of acute appendicitis during pregnancy at Maharat Nakhon Ratchasima Hospital. Patients & Methods: Descriptive study was performed in 83 pregnant weman with acute appendicits during 1 January, 2002 to 3 December, 2007, at the Department of Obstetric and Gynecology, Maharat Nakhon Ratchasima Hospital. Results: Frequency of acute appendicitis was 1: 496 pregnancies. Age group varied from 14 years to 39 years with median age of 24.4+5.4 years. More patients presented during second trimester. Most patients complained of right lower abdominal pain (79.7%) of 24 hours duration or less (87.3%) by 95.8, 71.8, and 75.0% during first, second, and third trimester, 60.8 and 55.7% of patients complained of nausea and vomiting, 64.6% were febrile (38.0oC). Physical examination revealed right lower quadrant tenderness in all patients, rebound tenderness 62.0%, abdominal guarding 13.9%, leukocytosis 84.8%, neutrophilia 50.6%, and positive ultrasonography 14.3%. Post operative complications included; infected wound 1.3%, first trimester abortion 12.5%, no second trimester abortion or preterm labor, and third trimester premature labor 25.0%. And most patients were successfully treated with tocolytic drug. Conclusions: The abdominal sign of patients during first trimester was the same as non-pregnancy, but was higher located during second and third trimester, positive ultrasonography 14.3%. Post operative complications were infected wound 1.3 %, abortion in first trimester 12.5%, no abortion or preterm labor during second trimester, premature labor 25.0% during third trimester and most patients were successfully treated with tocolytic drug.