Appendicitis in Pregnancy
Appendicitis is a condition where the appendix becomes swollen and inflamed. Acute appendicitis in pregnancy is the most common surgical emergency.
Appendicitis is a condition where the appendix is inflamed, swollen and infected. The appendix is located in the lower right area of the abdomen. It is a small protrusion in the shape of a worm like pouch and is attached to the large intestine. The functionality of appendix is unclear, especially since its removal does not seem to affect a person's health in any way. However, new studies are exploring the possibility that the appendix may contain and protect bacteria that are beneficial in the function of the human colon. The most common form of treatment for appendicitis is surgery and removal of the appendix.
Symptoms
If a pregnant woman experiences pain in the area to the right side below her abdomen, it is likely to indicate appendicitis, as that is the most common symptom irrespective of gestational age. The abdominal pain experienced as a result of appendicitis has a few defining characteristics. It usually occurs suddenly, and if it starts at night, will cause a person to wake up with a start. This pain may start near the belly button and then moves lower and to the right. It is a severe pain, and even in pregnant women it will be unlike any pain they have felt before. As time progresses, it quickly progresses in severity. It makes simple movements as well as taking deep breaths, coughing, or sneezing, extremely painful. The debilitating pain induces other changes, such as loss of appetite, nausea and vomiting, which may be viewed as other symptoms of appendicitis.
Diagnosis
Pregnancy makes appendicitis more difficult to diagnose. The altered state of the body makes appendicitis difficult to detect. The displacement of the appendix by the uterus and increased separation of the visceral and parietal peritoneum, decreases the ability to localize tenderness during a physical examination. The possibility of other conditions, such as pyelonephritis and twisted ovarian cyst, also need to be considered. Adding to this are physiological changes that take place in pregnancy, such as leukocytosis (raised white blood cell count) and a reduced tendency to develop hypotension and tachycardia. Also, some of its symptoms, such as nausea, and vomiting are similar to those experienced during pregnancy. Despite all these spokes, a patients history and physical examination are useful indicators of appendicitis. Responses of rebound tenderness and guarding, that usually indicate appendicitis are considered less common in late pregnancy, due to the loosening of the abdominal wall muscles. Ultrasonography, might prove useful during the first trimester, in detecting appendicitis.
Treatment
Surgery needs to be performed early for best results. Rupture of the appendix can be dangerous to mortality of the mother and her baby. Immediate surgery, along with perioperative antibiotics, can be vital in preventing the bursting of the appendix, and reduce the hazard it would present to both. A laparoscopic appendectomy or an open appendectomy may be performed, depending on what is best for the mother. Though both are considered equally safe, if conditions allow, laparoscopic surgery has the advantage of lesser narcotic use, better intraoperative visualization, reduced postoperative pain, quick return of bowel function, early ambulation and a shorter stay in the hospital post surgery. However, it does raise a few concerns, including increased intra-abdominal pressure and the use of carbon dioxide pneumoperitoneum.
Complications
While preterm, labor can arise during or after surgery. Although, preterm delivery is rare. In some cases, threatened premature labor has been due to a ruptured appendix. In such cases, emergency operation with the use of antibiotics was the best treatment. There have been cases where delay in operating has led to premature delivery.
A pregnant woman exhibiting any of the symptoms should contact her medical practitioner immediately. The health of a mother and her baby depends on proper care and prompt attention.
Symptoms
If a pregnant woman experiences pain in the area to the right side below her abdomen, it is likely to indicate appendicitis, as that is the most common symptom irrespective of gestational age. The abdominal pain experienced as a result of appendicitis has a few defining characteristics. It usually occurs suddenly, and if it starts at night, will cause a person to wake up with a start. This pain may start near the belly button and then moves lower and to the right. It is a severe pain, and even in pregnant women it will be unlike any pain they have felt before. As time progresses, it quickly progresses in severity. It makes simple movements as well as taking deep breaths, coughing, or sneezing, extremely painful. The debilitating pain induces other changes, such as loss of appetite, nausea and vomiting, which may be viewed as other symptoms of appendicitis.
Diagnosis
Pregnancy makes appendicitis more difficult to diagnose. The altered state of the body makes appendicitis difficult to detect. The displacement of the appendix by the uterus and increased separation of the visceral and parietal peritoneum, decreases the ability to localize tenderness during a physical examination. The possibility of other conditions, such as pyelonephritis and twisted ovarian cyst, also need to be considered. Adding to this are physiological changes that take place in pregnancy, such as leukocytosis (raised white blood cell count) and a reduced tendency to develop hypotension and tachycardia. Also, some of its symptoms, such as nausea, and vomiting are similar to those experienced during pregnancy. Despite all these spokes, a patients history and physical examination are useful indicators of appendicitis. Responses of rebound tenderness and guarding, that usually indicate appendicitis are considered less common in late pregnancy, due to the loosening of the abdominal wall muscles. Ultrasonography, might prove useful during the first trimester, in detecting appendicitis.
Treatment
Surgery needs to be performed early for best results. Rupture of the appendix can be dangerous to mortality of the mother and her baby. Immediate surgery, along with perioperative antibiotics, can be vital in preventing the bursting of the appendix, and reduce the hazard it would present to both. A laparoscopic appendectomy or an open appendectomy may be performed, depending on what is best for the mother. Though both are considered equally safe, if conditions allow, laparoscopic surgery has the advantage of lesser narcotic use, better intraoperative visualization, reduced postoperative pain, quick return of bowel function, early ambulation and a shorter stay in the hospital post surgery. However, it does raise a few concerns, including increased intra-abdominal pressure and the use of carbon dioxide pneumoperitoneum.
Complications
While preterm, labor can arise during or after surgery. Although, preterm delivery is rare. In some cases, threatened premature labor has been due to a ruptured appendix. In such cases, emergency operation with the use of antibiotics was the best treatment. There have been cases where delay in operating has led to premature delivery.
A pregnant woman exhibiting any of the symptoms should contact her medical practitioner immediately. The health of a mother and her baby depends on proper care and prompt attention.
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