ZenToks Publication

Chapter 9

Acute Appendicitis in Pregnancy: A Review

Abstract/Preface

Acute appendicitis is the most prevalent non-obstetric surgical emergency encountered during pregnancy and continues to be a significant contributor to maternal and fetal morbidity when there is a delay in diagnosis or treatment. Diagnosing appendicitis in pregnant patients presents particular challenges due to the physiological, anatomical, and biochemical changes associated with pregnancy, which may obscure classical clinical symptoms. A delay in diagnosis heightens the risk of appendiceal perforation, which is linked to preterm labor, fetal loss, maternal sepsis, and adverse neonatal outcomes. Imaging techniques, especially ultrasonography and magnetic resonance imaging (MRI), have become integral to the diagnostic process. Surgical intervention remains the cornerstone of treatment. Recent evidence and international guidelines advocate for laparoscopic appendectomy as the preferred surgical method for most pregnant patients, owing to its favorable maternal outcomes, reduced hospital stay, and lower rates of wound complications. Nonetheless, open appendectomy is still suitable in certain clinical scenarios. Emerging literature on non-operative management with antibiotics has garnered interest; however, current evidence indicates that surgery remains the standard of care due to concerns about treatment failure, recurrence, and maternal-fetal complications. Multidisciplinary collaboration among surgeons, obstetricians, anesthesiologists, radiologists, and neonatologists is essential for optimizing outcomes. This chapter explores the diagnostic and current recommendations for managing acute appendicitis during pregnancy.