Appendicitis during pregnancy: Signs and what to do

Appendicitis can be worrying at any time, but during pregnancy, it can be more difficult to distinguish the symptoms from other causes.

However, surgery to remove the appendix is very effective, no matter how far along the pregnancy is. The most important factor is an early diagnosis.

Read on to learn more about the symptoms, treatment, and recovery process for appendicitis during pregnancy.

Appendicitis is an infection of the appendix, which is a small organ that adjoins the colon. This infection usually develops due to a blockage, such as a hardened stool, swollen lymph node, certain infections, or growths.

Anyone can develop appendicitis, and it occurs at a similar rate in both pregnant and nonpregnant people.

Scientists estimate that appendicitis occurs in 1 in 181 to 1,700 pregnancies, with most occurring in the second trimester.

While it is a medical emergency, it is also treatable. However, there are additional considerations when diagnosing and treating the condition during pregnancy.

Some people experience symptoms that develop more slowly or in a different location. This is more likely to occur during pregnancy, as pressure from the fetus can move the appendix to a higher location.

When this happens, the pain may be on the right lateral side of the abdomen, rather than the lower-right corner. People may also have more nonspecific symptoms.

For this reason, it is important to seek immediate medical attention for any severe abdominal pain, fever, or other potential signs of infection, even if they do not exactly match appendicitis.

An obstetrician-gynecologist (OB-GYN) should assess pregnant people for appendicitis. Typically, they will begin by asking about symptoms and performing a physical examination.

The physical examination may involve pressing on the abdomen in various areas, which may temporarily worsen the pain.

MRI scans are very sensitive tests for appendicitis. Ultrasound is less sensitive but widely available, safe, and less expensive.

If appendicitis is likely, the doctor may recommend surgery to remove the appendix. Once they have, testing the tissue can confirm the infection.

There are three approaches to treating appendicitis.

This is a type of “keyhole” surgery that removes the appendix using minimally invasive techniques.

During the procedure, surgeons make several small incisions in the abdomen. They then use a camera to make precise cuts, removing the appendix from the body. This technique requires less time in the hospital than open surgery.

Open appendectomies also remove the appendix, but they involve larger incisions to open the abdomen.

There is not much high quality research comparing open and laparoscopic appendectomies in pregnant people, but the research that is available shows they have similar outcomes. This technique involves a longer recovery time and a longer hospital stay.

If the appendix has burst, open surgery is often necessary to irrigate and drain infectious material inside, which comes with a higher risk of complications.

Sometimes, doctors treat appendicitis with antibiotics alone. However, a 2023 study notes that while this option has increased in popularity, it may lead to worse outcomes during pregnancy.

After an appendectomy, people may wake up feeling groggy after anesthesia. They will recover in the hospital for a while. If they had laparoscopic surgery, they may be able to go home the next day.

If a person had open surgery or experienced complications, they may need to stay in the hospital for a few days.

People may need to rest and recuperate for 1 to 2 weeks before resuming their usual activities. During this time, it is important to avoid getting dressings wet and be careful when washing. Eating plenty of fiber and drinking enough water can also help with constipation.

Do not engage in strenuous activities or drive until fully recovered. If any of the following symptoms develop, it is important to tell a doctor right away:

If an appendectomy takes place close to a person’s due date, they should discuss their birth plan with an OB-GYN.

Below are the potential complications of appendicitis with and without treatment.

Without treatment, appendicitis can be life threatening for both the parent and the fetus. The potential risks include:

The risk of the appendix bursting is around 2% after 36 hours, then an additional 5% for every 12-hour interval that follows. This means the risk increases to 7% after 2 days, and to 17% after 3 days.

Over the following days, the risk of a ruptured appendix becomes significantly higher.

Appendectomies are usually low risk, including during pregnancy. However, any surgery can lead to complications.

While this list may sound frightening, it is important to remember that the risk of pregnancy loss and other complications dramatically decreases with appendicitis treatment.

If the surgery is “uncomplicated”, meaning the appendix has not ruptured and the procedure goes smoothly, the risk of preterm labor is 4%, and the risk of pregnancy loss is 2%. This is equivalent to 4 in 100 people and 2 in 100 people, respectively.

Additionally, some postsurgical complications are temporary or treatable. Speak with the medical team about the risks and how they will manage them.

It is also very important to disclose any other medical conditions a person has before the surgery.

Some of these are not serious, but some are medical emergencies, which is why it is crucial to get immediate medical attention for any severe or worsening abdominal pain.

Appendicitis can develop quickly, and the symptoms can be different in pregnant people. However, with a prompt diagnosis and treatment, it is treatable with minimal risk to the pregnancy.

Anyone with concerns that they may have appendicitis should seek immediate medical attention.