Residents’ Papers ObstetricsAppendicitis in pregnancy: New information that contradicts long-held clinical beliefs☆
Section snippets
Methods
All pregnant patients delivered at Good Samaritan Medical Center in Phoenix, Arizona, from January 1, 1986, to December 31, 1995, were reviewed. Records that were coded as “rule out appendicitis” or “appendicitis” were selected. In addition, all patients who had an exploratory laparotomy performed were screened to ensure the greatest possible data accuracy.
Data gathered from these records included the presenting complaint, gestational age at presentation and delivery, history, physical
Results
There were 66,993 deliveries during the 10-year study period; 67 of the women (0.1%) had a preoperative diagnosis of probable appendicitis. Acute appendicitis was confirmed histologically in 45 (67%) of the 67 women, for a true incidence of 1 in 1493 women in our population. Suspected appendicitis occurred in 17 cases (25%) in the first trimester, 27 cases (40%) in the second trimester, and 23 cases (34%) in the third trimester. The false-positive rate was 33% and varied slightly by trimester:
Comment
In our pregnant population the incidence of appendicitis is slightly higher than in an age-matched group of nonpregnant women described in the surgery literature. The proven incidence of acute appendicitis is similar in pregnant and nonpregnant women. The acceptable false-positive rate in pregnancy is 30%, which is very similar to our findings.
The classic signs and symptoms of acute appendicitis are abdominal pain, nausea and vomiting, low-grade temperature elevation, and leukocytosis. The
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