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September 28, 1957


JAMA. 1957;165(4):317-321. doi:10.1001/jama.1957.02980220001001

Extrauterine surgical complications of pregnancy, though rare, are likely to be serious. The most frequent such complication, in a series of 45,720 deliveries, was appendicitis. The urgency of the condition and the difficulty of the differential diagnosis are such that it is better to err on the side of unconfirmed diagnosis than to procrastinate and err on the side of missed diagnosis. Twenty-four appendectomies were done in this series, and the diagnosis was found correct in 22. Less frequent complications were torsion of an ovary or uterine tube, intestinal obstruction, acute cholecystitis, and the socalled round ligament syndrome. It is sometimes difficult to make a differential diagnosis between these conditions and others such as uterine anomalies, degeneration or torsion of a myoma, ectopic pregnancy, and premature separation of the placenta which may cause acute abdominal pain. Surgery was necessary in altogether 41 patients of this series. There were two maternal deaths, one from acute pancreatitis and the other from perforation in a patient with ulcerative colitis. Delay in operating is commonly excused by the fear of inducing an abortion, but abortion is less likely to follow after surgery than after procrastination in the face of persistent abdominal symptoms.