Lecture of appendicitis during pregnancy

2021-03-22 12:00 AM

Diagnosing appendicitis during pregnancy is often more difficult than usual because of atypical pain spots; especially if appendicitis occurs during labor

Preamble

Acute appendicitis accounts for 1/1000 to 1/2000 of pregnancies. Acute appendicitis can occur at any stage of pregnancy. However, appendicitis usually gets worse during pregnancy and has many negative complications for both mother and fetus.

As for the pathogenesis and the dangerous reason for the pregnant woman and the fetus is during pregnancy because the uterus is congested, inflammation is often worse. Moreover, due to inflammation that stimulates the uterus of pregnancy, it leads to miscarriage and premature birth. During the development of a pregnancy, other organs such as the colon, rectum, and large connective membrane are pushed up to cover the inflammatory appendix, so appendicitis ruptures pus quickly forming appendicitis or appendicitis. appendiceal abscess, little or no appendices mass formation.

Symptoms and diagnosis 

Clinical symptoms

Clinical symptoms in the first 3 months of pregnancy:

Clinical symptoms do not differ from a woman who is not pregnant:

Fever, rapid pulse, infectious facial expression.

Right pelvic pain.

Vomiting often occurs later, sometimes mistaken for vomiting in early pregnancy.

Mac Burney sign (positive), painful abdominal pressure in the right pelvic fossa.

Vaginal examination: The uterus corresponds to gestational age, the right sac is not full, pressure is pressed.

Clinical symptoms in the last 6 months of pregnancy:

Because the fetus develops more than the first 3 months, the uterus often pushes the appendix up and squeezes it out of the abdominal wall, so symptoms are often complicated, the disease is more difficult to diagnose, including symptoms:

High fever, rapid pulse, infectious facial expression.

Pain is usually higher than normal, such as on the pelvic crest, sometimes in the lower right rib. The abdominal pain was getting worse and worse.

Often have bowel disorders such as diarrhea, constipation, functional intestinal paralysis.

Examination: There is uterine contraction due to uterine stimulation. For women to lie on their back, push the uterus to the right, women often complain of pain, or for women to lie on their left so that the pregnant uterus is pushed to the left often detect appendicitis if pressed into the right pelvic fossa, lower ribs must help to determine the pain point more clearly.

Vaginal examination combined with abdominal manipulation: The right pocket is not full, pressure is less.

Subclinical

Blood test: WBC count increases, neutrophils increase.

Ultrasound: Diagnosis of the inflamed appendix is ​​easier in the first 3 months but more difficult in the last 6 months of pregnancy due to fetal development.

Diagnose

Diagnosing appendicitis during pregnancy is often more difficult than usual because of atypical pain spots; especially if appendicitis occurs during labor, the contraction of the uterus usually blurs the painful signs of the inflamed appendix.

Differential diagnosis

It is necessary to distinguish with the following diseases:

In the form of severe septic syndrome:

It should be distinguished from:

Right pyelonephritis, urinary tract infections (painful urination, burning urine, hematuria ...).

Acute cholecystitis (fever, gallbladder pain ...).

Adnexitis (pain in both sides of the pelvic fossa, fever).

Informs without fever:

Mainly based solely on pain signs, it should be distinguished from:

Signs of starting labor.

Hematoma after vegetables (in young vegetables).

Kidney cramp pain, liver abscess pain.

A complicated ovarian tumor (torsion).

Progression and prognosis

For pregnant women

If not operated in time, acute appendicitis will turn into appendices abscesses or peritonitis.

Whole peritonitis due to appendicitis ruptures pus after a miscarriage, usually worse after birth because the uterus goes back, causing pus to spread into the abdomen. Patients often suffer from infertility, ectopic pregnancy due to secondary infection that affects the aperture of the two tubes.

For the fetus

Appendicitis often leads to miscarriage, premature delivery, stillbirth in the uterus, and severe neonatal infection at birth.

Solving

For downline

If diagnosing inflammatory appendicitis at antenatal care, it is necessary to immediately transfer to higher levels for better conditions to resolve for the patient.

For upline

During pregnancy, if appendicitis is suspected, surgery should be done early.

Mac Burney surgery: If the appendix is ​​normal, it is necessary to remove the appendix and then suture it up. During surgery, try to avoid touching the uterus to reduce the risk of contraction of the uterus, always check the appendages for secondary inflammation, but not remove to avoid resection. wrong ovaries can conceive. If it is a purulent appendix (abscess of the appendix) or inflamed peritoneum due to rupture of the appendix, it is necessary to remove the appendix, wash the abdomen, and drain.

During labor, if it cannot be prevented, try to have a vaginal delivery. If the delivery is not possible, the abortion then removes the inflamed appendix. In case of necessity, partial hysterectomy is sometimes necessary.

In addition, it should be noted that to limit miscarriage, preterm delivery before and after cesarean section, patients must be given weight loss drugs (Papaverine) and Progesterone for the time necessary to help maintain the development of the fetus.

After surgery, attention should be paid to using high-dose antibiotics (which can be based on antibiotic therapy when taking inflammatory pus fluid).

Appendicitis during pregnancy is often difficult to diagnose, especially in the last 6 months of pregnancy. However, due to the complicated progression of the disease, it is necessary to early diagnose, detect and solve surgery to avoid negative consequences for mother and fetus caused by acute appendicitis.