Appendicitis in Pregnancy

Anatomy
The sixth week of human development the

appendix and cecum develop as outpouchings

of the caudal limb of the midgut loop.
The fifth month the appendix elongates into
its vermiform shape.
At birth the appendix is located at the tip of
the cecum
The adult appendix typically originates from
the posteromedial wall of the cecum because
of unequal elongation of the lateral wall of the
cecum, caudal to the ileocecal valve.

Anatomy

Anatomy
The appendix averages 9 cm in length, with

its outside diameter ranging from 38 mm

and its lumen ranging from 13 mm.
The base of the appendix is consistently
found by following the teniae coli of the
colon to their confluence at the base of the
cecum.
The appendiceal tip, however, can vary
significantly in location

Anatomy

Anatomy
The arterial supply of the appendix comes

from the appendicular branch of the

ileocolic artery, which originates posterior
to the terminal ileum and enters the
mesoappendix near the base of the
appendix.
Lymphatic drainage flows to lymph nodes
along the ileocolic artery.

Pathophysiology
1. Closed loop obstruction is caused by a fecalith

and swelling of the mucosal and submucosal

lymphoid tissue at the base of the appendix
2. Intraluminal pressure rises as the appendiceal
mucosa secretes fluid against the fixed
obstruction
3. Increased pressure in the appendiceal wall
exceeds capillary pressure and causes mucosal
ischemia
4. Luminal bacterial overgrowth and translocation
of bacteria across the appendiceal wall result in
inflammation, edema, and ultimately necrosis

Surgical Anatomy of
Appendectomy

Appendicitis in Pregnancy
The diagnosis of acute appendicitis in the

pregnant patient can be particularly challenging

Nausea, anorexia, and abdominal pain may be

symptoms of both appendicitis and normal

pregnancy.
The gravid uterus can displace the abdominal
viscera, shifting the location of the appendix from
the right lower quadrant
The differential diagnosis of appendicitis includes
certain conditions specific to pregnancy: ectopic
pregnancy, chorioamnionitis, preterm labor,
placental abruption, and round ligament pain.

Appendicitis in Pregnancy
In the first and early second trimesters, the

presentation of appendicitis is similar to

that seen in nonpregnant women.
In the third trimester, women may not
present with right lower quadrant pain due
to displacement of the appendix by the
gravid uterus

Appendicitis in Pregnancy
The pregnant patient should proceed directly

to appendectomy if appendicitis is suspected.

A normal appendix is not an uncommon
finding, as negative laparotomy has been
reported in approximately one-third of cases
due to the difficulty of diagnosis in this
population.
Negative laparotomy should not be
considered an error in diagnosis, because the
risk to the fetus varies directly with the
severity of appendicitis.

Appendicitis in Pregnancy
In one series, fetal loss occurred in only 1

(3%) of 30 negative laparotomies

Fetal mortality rises to 5% in cases of
nonperforated appendicitis, and increases
to 20% when the appendix perforates
Early negative exploration is justified to
minimize the likelihood of progression to
perforation

Appendicitis in Pregnancy
Baer et al. emphasized the displacement of

the appendix by the gravid uterus and the

corresponding relocation of the pain.
The performance of any operation during
pregnancy carries a risk of premature labor
of 10 to 15%, and the risk is similar for both
negative laparotomy and appendectomy for
simple appendicitis

Appendicitis in Pregnancy

Appendicitis in Pregnancy
In obstetrics the most frequent uses of

progesterone :
The treatment of threatened abortion,
Prevention of recurrent miscarriage
The support of the luteal phase in assisted

reproduction programmes
Threatened preterm labour.
Randomized, controlled trials showed that

women who received progesterone were

statistically significantly less likely to have
recurrent miscarriages before 34 weeks.

Appendicitis in Pregnancy
Vaginally dosed progesterone is being

investigated as potentially beneficial in

preventingpreterm birthin women at risk
for preterm birth.
The initial study by Fonseca suggested that
vaginal progesterone could prevent preterm
birth in women with a history of preterm
birth.
The hormone treatment was administered
vaginally every day during the second half
of a pregnancy.

Thank You