Appendicitis in pregnant women has hidden symptoms. Signs of appendicitis during pregnancy in the early and late stages

Expectant mothers usually associate abdominal pain with pregnancy. In most cases this is true. This is why it is possible to miss the symptoms of appendicitis during pregnancy. To prevent this from happening, you need to know how this insidious disease manifests itself.

Appendicitis, or inflammation of the appendix, is one of the most common diseases of the abdominal organs. Among women with appendicitis, it occurs in up to 3-3.5% of pregnant women. The incidence of acute appendicitis in pregnant women is slightly higher than in other women.

The exact causes of appendicitis are not fully known. There are several versions. According to one of them, it is believed that the development of appendicitis is directly related to blockage of the lumen between the cecum and the appendix. Blockage can occur due to the formation of small fecal stones - coprolites, which close the lumen, thereby disrupting the blood supply in the appendix, which leads to its swelling and inflammatory manifestations.

Pregnancy may be a predisposing factor for the development of appendicitis. This is explained by the growth and enlargement of the uterus, which, taking up more and more space in the pelvis, compresses the appendix, disrupting its blood supply, which leads to the development of inflammation.

Symptoms of appendicitis during pregnancy

There are simple (i.e. catarrhal) and destructive (phlegmonous, gangrenous and perforated) forms of appendicitis. All of them are stages of development of a single process, and for their occurrence during the progressive course of the disease a certain time is necessary: ​​for catarrhal appendicitis (when only the mucous membrane of the appendix is ​​involved in the inflammation process) - 6-12 hours, for phlegmonous (changes can be traced on the mucous, submucosal and partially on the muscle layer) - 12-24 hours, for gangrenous (when all layers of the wall of the appendix die off) - 24-48 hours: later perforation of the appendix may occur, in which the intestinal contents enter the abdominal cavity.

Manifestations of appendicitis largely depend on pathological changes in the appendix, as well as on its location in the abdominal cavity. As long as the inflammatory process is limited to the appendix itself, without moving to the peritoneum - the layer of connective tissue covering the walls and organs of the abdominal cavity - the manifestations of the disease do not depend on the location in the abdominal cavity relative to other organs and are expressed by pain in the upper third of the abdomen, which gradually shift down to the right half of the abdomen. This may cause nausea and vomiting. Abdominal pain can be minor and occur not only in the right iliac region, but also in other parts of the abdomen. Often, pain upon examination is not immediately detected and is detected much higher than the uterus; often the greatest pain is detected in the right lumbar region. Characteristically, the pain intensifies when lying on the right side, due to the pressure of the pregnant uterus on the inflamed lesion.

With the further development of the inflammatory process, pain appears in the right iliac region - in the lower abdomen or higher, up to the hypochondrium, depending on the degree of displacement of the appendix by the uterus, that is, from. Symptoms of peritoneal irritation (pain when suddenly removing the hand pressing on the anterior abdominal wall) are absent in pregnant women or are mild due to stretching of the abdominal wall. In pregnant women, all symptoms may be mild and appear late.

By medical issues be sure to consult your doctor first

Is it possible to promptly recognize appendicitis in pregnant women, the symptoms of which do not manifest themselves as usual? Why does it occur?

There are many prerequisites for the occurrence of the inflammatory process, but the main one is an enlargement of the uterus, which causes significant displacement internal organs, in particular, the intestines. Constant poor circulation in the peritoneal area, which gradually increases, can cause inflammatory processes not only in the appendix, but also in other organs.

There are other reasons:

• decreased general immunity;
• displacement of the appendix location;
• the appearance of frequent constipation as a consequence of poor nutrition;
• individual anomaly of the location of the appendix.

Localization of pain in appendicitis

The appendix is ​​an extension of the cecum, which is considered an atavism. It does not perform any functions, does not bear the load during the digestion process, and can become inflamed and cause big problems. It is located in the lower abdomen on the right; pain during its inflammation is most often localized there, but its accurate diagnosis is sometimes quite difficult.

Despite the signs of appendicitis in women during pregnancy, it is impossible to determine the disease and make a diagnosis only from their words. Difficulties with diagnosis arise because the growing fetus gradually displaces all organs, so it is impossible to say with certainty that the pain is for this reason.

Complicating diagnosis is the fact that different people it may not be located in the same place. In addition, at the early stage of the inflammatory process, the pain is usually diffuse in nature and its clear localization means that the situation is becoming threatening.

If we try to summarize the available information, then signs of appendicitis during pregnancy can manifest themselves in the forms described below.

• According to average body measurements, the cecum may be located on the right, between the hypochondrium and the pelvis. In this case, its individual location is possible - it can be shifted towards the liver or bladder. In this regard, additional symptoms may be added to the pain resulting from the development of appendicitis during pregnancy, the symptoms of which are noticeable. When the appendix is ​​located higher or lower, this causes nausea, even vomiting, discomfort in the stomach or sensations like inflammation of the genitourinary organs. In this case, the pain may radiate to the kidney area, the inguinal fold on the right, or the right thigh.
• There were cases of the onset of inflammation, which made itself felt by pain on the left, gastric colic, and only as the disease progressed did the painful area shift down to the right.
• You can expect a standard location of the pain area if the period is short, and as the fetus grows, it will be located higher and higher: at the level of the solar plexus or closer to the ribs.

It should be remembered that this is not necessarily appendicitis; symptoms during pregnancy, especially in the last trimester, can occur for various reasons, for example, quite severe pain appears with increased gas formation. Such probabilities further complicate the diagnosis of appendicitis in pregnant women.

Signs of appendicitis

However, you should know the characteristic symptoms of appendicitis in pregnant women, which occurs precisely as a result of inflammation of this small appendix:

• the pain continues to increase, the condition quickly worsens, the nature of the pain is colicky;
• when moving, when trying to lie on the right side, the pain becomes stronger, but if you lie on your back and pull your legs towards your stomach, it weakens;
• when trying to determine the development of appendicitis by pressing on the abdomen and abruptly releasing it, you may not get results; in pregnant women, the expected pain does not always occur, even in the case of developing inflammation;
• the appearance of weakness, even fainting;
• an increase in temperature is possible, and the thermometer will show different values ​​in the rectum and armpit;
• Nausea and vomiting may occur, but this symptom is more often interpreted as toxicosis, especially if the period is short;
• A complete blood count will reveal the presence of an increased number of red blood cells.

Since all signs of appendicitis in pregnant women, even with intense manifestations, are not specific, an examination will be prescribed.

Diagnosis of appendicitis

An accurate diagnosis can be made immediately only through examination using laparoscopy. Through a small puncture, a probe with a sensor is inserted into the suspected area of ​​localization of the cecum to see its condition. If there are signs of developing inflammation, the appendix is ​​immediately removed. However, this method is not available in all clinics.

Examination by laparoscopy

If there is no appropriate equipment, then if there is suspicion, the woman is placed in a hospital, where her condition is monitored. If there is a noticeable deterioration, the diagnosis is confirmed. In addition, a urine test is performed. Considering that the symptoms of appendicitis in women during pregnancy and signs of inflammatory diseases of the genitourinary system are similar, the absence of leukocytes in the urine may indicate appendicitis, their presence is a sign of bladder or kidney disease.

Ultrasound is also used to determine the condition of the cecum, but in some cases it is ineffective.

If classical methods fail to confidently determine the presence of pathology, the woman remains under medical supervision. In this case, you should not take painkillers so that the picture of the condition is clear and the signs of appendicitis in a pregnant woman enable doctors to analyze and take measures in accordance with them.

Is it possible to have surgery?

Treatment of an inflamed caecum can only be surgical, and this should not be postponed under any circumstances, since this disease poses a serious threat to life.

Removal of the appendix in the usual surgical way is performed under anesthesia, the patient is prescribed antibiotics that will cause minimal harm to the mother and child. This is necessary to prevent inflammation after surgery, as well as to prevent infection of the fetus.

Therapy during the recovery period includes vitamins and medications that help normalize blood flow and good intestinal function. Medications are also recommended to maintain the tone of the uterine muscles and prevent cramps. Bed rest is usually prescribed.

The expectant mother who had to undergo surgery will be under the supervision of a doctor until the end of the pregnancy, since there is a risk of premature birth.

If the surgical intervention was carried out in the last weeks of gestation, then enhanced monitoring of the condition of the expectant mother and fetus is carried out, as well as particularly careful monitoring of the birth process. This is explained by the fact that when pushing, the surgical sutures may come apart.

The danger of inflammation of the appendix

Such a pathology occurs quite often during pregnancy, about 5% of women different dates are faced with this problem. Therefore, there is no need to be afraid, the main thing is to seek help if pain occurs.

Under no circumstances should you self-medicate, take painkillers, or postpone a visit to the clinic. The occurrence of colicky or nagging pain can mean incipient appendicitis during pregnancy, the consequences for the child can be tragic. Therefore, it is better to play it safe.

There is some risk of exposure to medications that a woman will have to take before and after surgery, but the risk of using these medications is much lower than the consequences of peritonitis, which will begin if the inflamed appendix is ​​not removed in time. In this case, the woman may die.

Therefore, if the doctor is not sure that the cause of the pain lies elsewhere, he has to decide on his own responsibility whether to prescribe an operation.

A particularly dangerous situation arises if a pregnant woman experiences acute appendicitis, in which case the lack of emergency measures within a short time can even lead to death.

However, an uncomplicated form of appendicitis occurs more often, in more than half of women. At the end of the gestation period, the risk of developing pathology is higher; inflammation can become severe form, for example, phlegmonous, which will develop into peritonitis.

The degree of risk differs at different periods, but there are sad statistics:

• in an uncomplicated form, spontaneous abortion or unsuccessful birth occurs in 15% of cases;
• the transition of appendicitis to peritonitis, in 30% of cases ends in fetal death. This is a consequence of the general condition of the woman with the development of peritonitis, in which normal interaction with the fetus and its supply of oxygen becomes impossible.

Possible complications that may arise at any time:

• loss of a child;
• early delivery;
• various complications after surgery;
• acute intestinal obstruction;
• dysfunction of the uterine muscles;
• lack of oxygen in the blood, which can lead to fetal hypoxia;
• Bleeding may appear after childbirth.

The highest risk of negative consequences occurs in the first few days after surgery.

Conclusion

If you experience pain, weakness, or nausea, you should not attribute everything to toxicosis. At an early stage, signs of appendicitis may be similar to the usual minor ailments of a pregnant woman, so it is better to check with your doctor.

Appendicitis is the most common cause surgical intervention during pregnancy. Among pregnant women, 2-5% of women develop appendicitis. A predisposing factor is an increase in the volume of the uterus, which can cause displacement of the appendix and disruption of its blood supply. And this, in turn, leads to inflammatory processes. There are other reasons for the development of appendicitis during pregnancy: a tendency to, displacement of the cecum, disruptions in the immune system, which leads to changes in the properties of the blood. Nutrition and abnormal locations of the appendix in the abdominal cavity play an important role.

Diagnosis of the disease includes a blood test, urine microscopy, and ultrasound. But only with the help of laparoscopy can appendicitis be diagnosed for sure. In any case, it all starts with an examination and interview of the woman.

The main symptoms of appendicitis during pregnancy

How to recognize appendicitis? Symptoms of inflammation in pregnant women are the same as in everyone else. In patients, it often increases, and the indicators in the armpit and in the rectum can differ greatly. An essential symptom is a sudden onset of colicky pain, usually localized in the right iliac region. But on later Localization of pain may shift higher. During an acute attack, the patient remains for a long time in a forced position on her back with her legs brought to her stomach, breathing is shallow and rapid. Pulse rate, vomiting, bloating, and shortness of breath should also be taken into account. General analysis blood shows an increase in the number of red blood cells.

The longer the period, the more difficulties may arise during diagnosis, surgery and postoperative rehabilitation. Therefore, it is very important to make a diagnosis on time. Pregnancy itself complicates the recognition of inflammation of appendicitis, especially in the second half. Many symptoms are considered normal during pregnancy.

Regardless of the duration, inflammation of appendicitis is resolved exclusively by surgery. And the sooner this is done, the lower the risks for mother and child. Therefore, if you experience characteristic or simply suspicious abdominal pain, you should immediately consult a doctor. Self-medication for false causes delays the correct diagnosis and is extremely dangerous.

The development of appendicitis may pose a threat of termination of pregnancy, but is in no way an indication for this (regardless of the stage of pregnancy and the form of appendicitis). Caesarean section is resorted to only in exceptional cases. The need for cleaning may also arise in case of too large, when this interferes with the operation.

In addition to the threat of miscarriage, appendicitis during pregnancy threatens a number of other complications:

• postoperative infectious processes;
• intestinal obstruction;
• in rare cases - premature placental abruption;
• abnormalities of uterine contractility;
• fetal hypoxia;
• bleeding in the afterbirth period.

In the first postoperative days, the likelihood of complications is very high. Therefore, a number of features are taken into account. After surgery, do not apply weights or ice to the abdomen (this can cause pregnancy complications). Patients are prescribed drugs that relax the muscles of the uterus, and antibiotics to prevent infectious complications. Measures are being taken to maintain pregnancy, as well as improve bowel function. Pregnant women are prescribed long-term bed rest and sedatives. After discharge from the hospital, such women are included in the risk group for the threat of early termination of pregnancy. The condition and development of the fetus (which is believed to have suffered an intrauterine infection) is closely monitored. If childbirth occurs within a few days after the operation, it is taken very carefully and carefully: the abdomen is tightly bandaged, full anesthesia is used with extensive use of antispasmodics, and intrauterine prophylaxis is carried out.

Appendicitis, including during pregnancy, is an inflammation of the vermiform appendix - the appendix. Accompanied by severe pain in the lower abdomen with right side, signs of intoxication, increased temperature. For diagnosis, a blood test, abdominal ultrasound, and laparoscopy are prescribed. Therapy consists of surgical removal of the appendix.

Causes of appendicitis during pregnancy

During pregnancy, appendicitis is detected in 0.05-0.12% of women. The disease can have a hidden course, so it is often diagnosed in late stages, which can be dangerous for the body of the mother and fetus.

Appendicitis during pregnancy early stages accompanied by pain in the lower abdomen

The following factors contribute to the development of the inflammatory process during pregnancy:

• frequent constipation. They are typical for pregnant women due to decreased sensitivity of the muscle wall and worsening intestinal motility. Due to constipation, the contents of the appendix can stagnate, and pathogenic microflora can develop inside it;
• reducing the acidity of gastric juice. This phenomenon is observed in women who suffered from chronic hypoacid gastritis before pregnancy. As a result of displacement of internal organs due to compression by the uterus, an exacerbation of the pathology may occur. A decrease in acidity can cause activation of the gastrointestinal microflora;
• displacement of the appendix and cecum. The constantly enlarging uterus puts pressure on parts of the large intestine. As a result, the appendix can become bent, its emptying and blood circulation worsen, which leads to inflammation;
• decreased immunity. So female body tries to protect the fetus from rejection, so the pregnant woman becomes vulnerable to any infectious diseases.

All of the above factors lead to the activation of opportunistic microflora present in the intestines. The causative agents of appendicitis can be staphylococci, Escherichia coli.

Stages of the disease

Appendicitis occurs in several stages.

1. Catarrhal. Inflammation affects the mucous membrane of the appendix and its submucosal layer. This is a mild form of the disease, lasting approximately 6 hours after the onset of inflammation. If an inflamed appendix is ​​diagnosed and removed at this stage, there should be no complications.
2. Phlegmonous. The muscle layer and serous membrane are involved in the inflammatory process. It begins immediately after the catarrhal form and lasts up to 24 hours.
3. Gangrenous. Partial or complete destruction of the appendix occurs. The most unfavorable form of the disease lasts from 24 to 72 hours after the onset of inflammation. The contents of the appendix can enter the abdominal cavity, causing sepsis.

The milder the form of the disease, the fewer complications. Therefore, if any symptoms appear, you should consult a doctor.

Symptoms of appendicitis during pregnancy

Symptoms of the disease depend on the stage of pregnancy:

• in the first trimester, symptoms do not differ from those observed in women before pregnancy. A sudden cutting pain appears in the lower abdomen on the right. It can be constant or paroxysmal, radiating to the lumbar area. In the early stages, appendicitis is also characterized by nausea, vomiting, diarrhea, and tension in the abdominal muscles. Pregnant women may confuse such symptoms with early toxicosis, so they do not always seek help in time;
• at 4-8 months the symptoms are erased. Pain with appendicitis is moderate, localized on the right under the ribs. Pregnant women mistake them for manifestations developing pregnancy. An increase in temperature up to 37.5 degrees, nausea and vomiting may be observed;
• Before or during childbirth, appendicitis is difficult to diagnose. Signs are masked by contractions. Therefore, inflammation of the appendix can be suspected based on other manifestations - hyperthermia, weakening of labor. Also, with appendicitis, there may be increased pain on the right side during the period between contractions;
• After childbirth, a typical course of appendicitis is characteristic. It is accompanied by pain, nausea, and bouts of vomiting. Muscle tension is weakly expressed, since muscle tone has not yet been restored after gestation.

Any uncharacteristic signs should prompt you to consult a doctor. If surgery is not performed on time, life-threatening complications may develop.

Characteristic symptoms of appendicitis are abdominal pain and nausea

Diagnosis of appendicitis

In approximately half of cases, appendicitis is confused with the threat of miscarriage. Late diagnosis of the disease in women worsens prognoses.

A number of methods are used to make a correct diagnosis:

• general blood test. Increased ESR and leukocyte values ​​characteristic of appendicitis are also observed with normal course pregnancy. Therefore, these indicators must be assessed over time - a rapid increase in inflammatory changes may indicate appendicitis;
• Ultrasound of the abdominal cavity. The appendix is ​​normally not visible on ultrasound. But with appendicitis, it is visualized as a formation with a diameter of 6-10 mm, which extends from the cecum;
• diagnostic laparoscopy. An effective procedure that detects inflammation in 93% of cases. But it has a number of contraindications. Until 16-18 weeks, this technique is prohibited in case of atypical pregnancy. And at a later stage, the visibility of the cecum will be impaired due to the enlargement of the uterus;
• urine microscopy. Allows you to identify red and white blood cells and bacteria in the urine. Such changes are observed in diseases of the kidneys and bladder. A normal urine test accompanied by unpleasant sensations is characteristic of appendicitis.

Taking into account the trimester of pregnancy, differential diagnosis is carried out with early toxicosis, gastritis, pancreatitis, cholecystitis, late toxicosis, pyelonephritis, ectopic pregnancy and some other diseases. Therefore, the patient can be prescribed a consultation with a number of doctors - a urologist, nephrologist, hepatologist, gastroenterologist.

Treatment of an inflamed appendix

If appendicitis is detected in a pregnant woman, urgent hospitalization and subsequent removal of the appendix are required. Laparoscopic surgery is recommended. If appendicitis is diagnosed during childbirth, surgery will be scheduled immediately after the end of the birth process. If there are manifestations of gangrenous appendicitis, this is an indication for simultaneous cesarean section and removal of the inflamed appendix.

At periods of more than 18 weeks, before scheduling the removal of the appendix, its exact position is determined, taking into account the displacement of the cecum under the pressure of the uterus.

After surgery, it is necessary to prevent complications of appendicitis. To restore intestinal motility, solar plexus diathermy is prescribed in the first trimester, and lumbar diathermy in subsequent trimesters. To prevent the development of infection, antibiotics that are safe for the fetus are prescribed.

To prevent miscarriage after appendicitis, the following recommendations must be followed:

• bed rest should last about a week;
• for uterine contractions, vaginal suppositories with papaverine are prescribed;
• moderate benefits after discharge physical activity to prevent the occurrence of adhesions. To avoid tearing the seam, do not lift heavy objects;
• in the early stages, you can use a bandage, but if it puts a lot of pressure on the abdomen, it is better to stop wearing it;
• In the first 2 weeks after surgery, it is better to carry out hygiene procedures in the shower. They should be used daily, and after washing the seam should be treated with an antiseptic.

The prognosis of the disease depends on the duration of pregnancy, the speed of detection of appendicitis and the operation. The sooner you start therapy, the higher the chances of avoiding complications.

Scar left after appendix removal

Consequences of appendicitis during pregnancy

Appendicitis during pregnancy can cause the following complications:

• rupture of the appendix. In this case, serious consequences may occur - peritonitis with severe intoxication, sepsis, pylephlebitis;
• early miscarriage and premature birth in late gestation;
• after surgery - the risk of placental abruption, fetal hypoxia, and fetal infection;
• if surgery is performed before childbirth, this can lead to labor abnormalities and bleeding.

According to statistics, fetal death with uncomplicated appendicitis is observed in 2-7% of cases, and with gangrenous appendicitis - in 28-30%. The maternal mortality rate is 1.1%.

Prevention

To prevent appendicitis in women during pregnancy, the following recommendations must be followed:

• adjust your diet. Eat easily digestible semi-liquid foods to improve digestion and prevent the development of constipation;
• don't overeat. Follow the diet - eat small portions 5-6 times a day;
• treat acute gastrointestinal diseases, observe the prevention of chronic pathologies.

The above recommendations do not provide a 100% guarantee that the inflammatory process in the appendix will not begin. If you experience discomfort in the lower abdomen, you need to consult not only a gynecologist, but also a gastroenterologist.

Pregnant women are at risk of developing appendicitis. Therefore, you need to carefully monitor your feelings. If there is discomfort, a comprehensive examination is needed, since such manifestations may indicate other diseases - ectopic pregnancy, pyelonephritis, pancreatitis and others.

Inflammation of the appendix, or appendicitis, is diagnosed, according to medical statistics, in 3.5% of pregnant women. Sometimes the very process of carrying a child can trigger an attack.

Pregnant women do not always pay due attention to pain symptoms, associating them with their position. Ignoring an attack and calling for help late medical care threatens serious complications.

The pain syndrome in this pathology depends on its form, which determines its course and manifestation of symptoms.

The disease develops depending on the type of acute appendicitis, which in medicine is divided into catarrhal and destructive. These forms differ in the time of development of symptoms: with catarrhal acute pain appears in the first 12 hours after the onset of the inflammatory process, and with destructive pain, the first signs may appear after two days.

The general symptoms of the acute course of the pathology in pregnant women do not differ from the general clinical ones, but they can manifest themselves differently depending on the anatomical location of the appendix and individual characteristics every patient.

In general cases, the onset of the disease is associated with the appearance of pain in the upper abdomen, which is often preceded by discomfort from the digestive system: gastric upsets, excessive gas formation, bloating.

Such symptoms can be observed within 24 hours after the onset of inflammation, after which the localization of pain moves to the right iliac region.

The characteristic features of pain syndrome in acute appendicitis are:

• The pain increases gradually; if it appears suddenly and sharply, then it is more likely a symptom of other diseases, for example, a perforated ulcer of the stomach and duodenum, an attack of cholecystitis or pancreatitis.
• During an acute attack, the pain has no specific localization and is individual in nature. In some patients it is determined in the umbilical region, in others - in the epigastric region.
• After the painful sensations move down, their character changes from periodic to constant, the sensations become dull, and the patient’s general condition noticeably worsens.
• With minimal stress, for example, when coughing, the discomfort increases noticeably.

During pregnancy, the nature of pain during the acute course of the disease is different, since the increasing size of the uterus affects the location of the internal organs, such changes appear in the second and third trimester of pregnancy. The localization of pain shifts upward, while the symptoms become less pronounced.

The specificity of the manifestation of signs of acute appendicitis in pregnant women is also as follows:

• the pain appears unexpectedly and is cutting in nature, but it does not stop even for a short time;
• a few hours after the onset of the attack, the localization of pain shifts to the right iliac region;
• discomfort intensifies if a woman lies on her right side and presses her right knee to her stomach;
• When lying on the left side, the discomfort subsides somewhat.

Expert opinion

Pain in acute appendicitis can also radiate to other organs, so for correct diagnosis it is important to take into account the whole range of symptoms.

Sometimes, when the pathology worsens, the pain may decrease for a while, but this is not a sign of the subsidence of the inflammatory process. On the contrary, this may be evidence that the purulent contents of the inflammation have spilled into the abdominal cavity, which is fraught with the most serious complications in the form of peritonitis.

Other symptoms indicating pathology

In addition to determining the location of pain, the doctor pays attention to the following features of the patient’s condition:

• disturbances in the functioning of the digestive system;
• constipation;
• decreased appetite;
• heartburn;
• nausea;
• vomit.

Vomiting is the most dangerous symptom of acute appendicitis, since it is a consequence of rupture of the inflamed appendix and spillage of pus in the abdominal cavity. Its presence may indicate the development of peritonitis.

Also a sign of the onset of inflammation is an increase in temperature to 38 - 39 degrees, chills, and weakness.

Consequences without treatment

One of the most dangerous complications of acute appendicitis without timely assistance can be peritonitis, that is, the transition of inflammation to the abdominal cavity. Pathology can be of two types:

• limited peritonitis, which, with adequate treatment measures, does not pose any threat to the patient;
• diffuse, that is, the immediate development of an inflammatory process in the abdominal cavity, which, under unfavorable circumstances, can lead to the death of the patient.

Serous peritonitis develops in the first 12 to 20 hours after the transition of the inflammatory process to the destructive stage.

Other dangerous consequences of acute inflammation without the necessary treatment include:

• the occurrence of infiltration and the development of adhesions;
• the appearance of an abscess, that is, a significant focus of suppuration, which can result in a breakthrough of purulent contents into the abdominal cavity or other internal organs;
• blood poisoning (sepsis), which can be caused by peritonitis or failure to comply with antiseptic measures during surgery to remove appendicitis.

Diagnosis of the expectant mother

During pregnancy, the symptoms of acute appendicitis may not be obvious; they are often similar to signs of other pathologies of internal organs, so the doctor must carefully examine the patient and collect anamnesis. It is important to distinguish this pathology from, for example, placental abruption, premature labor, or gestosis.

What makes diagnosis difficult is that an enlarged uterus and an enlarged abdomen complicate examination. In addition, in pregnant women, especially at longer periods, there is no symptom of tension in the muscles of the abdominal wall, which is typical for acute inflammation.

During the initial examination, the patient should be placed on a hard couch and asked to indicate the localization of pain in different positions: on one side and the other, on the back. Next, an examination is carried out using palpation, which must be performed with extreme caution.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

In medicine, several special tests have been developed to detect acute appendicitis, which every doctor knows. Based on them, foci of pain are determined in different positions and with different palpation methods.

Mandatory for a reliable diagnosis of acute appendicitis in pregnant women is a vaginal and rectal examination, as well as examination using instrumental methods.

For ordinary patients, ultrasound is the most informative diagnostic method, but in the case of a pregnant woman, this technique sometimes cannot give a visual idea of ​​​​the condition of the appendix, since the appendix may not be visible on the monitor due to the enlarged uterus. At the same time, ultrasound is best method to differentiate pathology from the threat of miscarriage or diseases of the genitourinary system.

Laboratory testing of blood and urine is necessary. The presence of an inflammatory process indicates increased level leukocytes, but when assessing test results, it is necessary to take into account that in pregnant women this indicator differs from the norm. Also a sign of acute appendicitis is a rapid heartbeat and the presence of symptoms of intoxication of the body.

Removal of appendicitis during pregnancy

The only treatment for this pathology is resection of the inflamed appendix, which can be performed either by conventional surgery or by laparoscopy.

During the traditional operation, under local anesthesia, an incision approximately 10 cm long is made above the area where the inflamed appendix is ​​located, and the appendix is ​​removed through this access. Next, sutures are applied, which, if there are no complications, are removed after about a week, depending on the individual ability of the tissue to regenerate.

This method of performing an operation to remove the appendix is ​​standard and absolutely safe, but after surgery, a scar remains on the patient’s abdomen, which brings significant cosmetic discomfort to the woman.

A more modern and much less traumatic method of removing the appendix is ​​an operation performed laparoscopically using optical instruments. In case of pregnancy, this operation is optimal, since it is performed through a small puncture of the anterior abdominal wall. This surgical intervention does not leave noticeable marks on the skin, is not associated with pain and significantly shortens the recovery period.

The only drawback of this method is its inaccessibility, since not all clinics are equipped to perform such surgical operations.

To learn whether it is safe to have surgery during pregnancy, watch this video:

Recovery after surgery

The rehabilitation period in case of pregnancy should take place in a clinic under the constant supervision of specialists, since it is associated with certain characteristics.

For ordinary patients, immediately after surgery, ice is applied to the abdomen in order to relieve the symptoms of inflammation and alleviate the condition after the operation, however, such procedures are contraindicated for pregnant women, since they can harm the unborn child.

To prevent various complications in the postoperative period and prevent possible miscarriage, medications are prescribed to relax the uterine muscles in order to minimize the risk of contractions.

In addition, a woman must take antibacterial drugs approved during pregnancy to avoid infection of internal organs.

To relieve discomfort during the recovery period, pregnant women are advised to undergo physiotherapeutic procedures, in particular diathermy in the solar plexus and lumbar region. Such measures are a good preventative measure for restoring the functions of the digestive system and preventing premature birth.

Among other non-drug means, acupuncture and other reflexology methods will help improve the condition of a pregnant woman’s body.

To prevent uterine contractions, vitamin complexes, mild sedatives, and strict bed rest are prescribed. If uterine contractions cannot be avoided, the patient must take antispasmodics, for example, suppositories with papaverine.

One of the possible complications of surgery to remove appendicitis during pregnancy is fetal hypoxia and other pathologies, therefore, if labor occurs immediately after surgery, doctors should make every effort to ensure that this process takes place as quickly as possible.

Preterm labor may not begin immediately after surgery, so after discharge from the clinic, the woman should be included in the risk group. The consultation should include regular examinations of the condition of the unborn child, ultrasound examinations, as well as an analysis to determine the condition of the placenta and the fetal circulatory system.

If research results reveal a risk of intrauterine disorders in the fetus, the woman should be admitted to a hospital and prescribed a course of treatment aimed at improving the condition of the unborn child. Typically, such a course includes glucose, vitamins, drugs to improve cardiac activity and prevent early labor.

In most cases, inflammation of appendicitis does not pose any threat to either the mother or the child, especially when contacting specialists at the first signs of pathology. Modern methods surgical operations make it possible to remove the appendix painlessly and without cosmetic defects; in addition, such operations significantly minimize the risks of miscarriage and do not harm the unborn child.