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JAMA Insights
July 1, 2019

Diagnostic Imaging in Pregnant Patients With Suspected Appendicitis

Author Affiliations
  • 1Division of Trauma and Critical Care, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA. 2019;322(5):455-456. doi:10.1001/jama.2019.9164

Diagnosing the source of acute abdominal pain during pregnancy is challenging. While obstetric causes are the most common source, acute appendicitis is the most common nonobstetric surgical emergency. Yet, diagnosing acute appendicitis can be particularly challenging during pregnancy because of the overlap in symptoms between appendicitis and normal pregnancy, the higher likelihood for nonclassic symptoms with appendicitis during pregnancy, anatomic changes related to the gravid uterus, and the physiologic leukocytosis of pregnancy. These diagnostic challenges can lead to the development of complications from a delay in diagnosis and treatment or misdiagnosis resulting in a negative appendectomy. Both scenarios have been associated with increased risks for maternal and perinatal morbidity. In the largest study to date, which included 94 789 patients, appendectomy for perforated appendicitis was associated with a 6% rate of fetal loss and 11% rate of early delivery; for negative appendectomy, the rate of fetal loss was 4% and the rate of early delivery was 10%.1 Compared with simple appendicitis, perforated appendicitis (odds ratio, 2.69) and negative appendectomy (odds ratio, 1.99) are the major factors associated with fetal loss. These data highlight an opportunity to improve strategies to allow for more timely and accurate diagnosis of appendicitis to reduce the risks of perforation or unnecessary operation in pregnant patients and improve perinatal outcomes.

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