What kind of pain can occur with appendicitis during pregnancy?

Acute appendicitis during pregnancy appears at the 4th or 5th month of gestation. Rarely occurs at 2 or 8 months. The disease manifests itself in 5% of cases. The risk increases after childbirth, and the rate reaches 8%. Signs of inflammation are similar to other disorders of internal organs or are related to health conditions. Therefore, it is difficult to detect the first symptoms. Appendicitis is a dangerous disease that affects the health of women and babies. Treatment consists of surgery. Therefore, the likelihood of complications occurring after surgery increases.

Does appendicitis occur during pregnancy?

Inflammation of the cecal appendage occurs in women more often during pregnancy. The disease is associated with an increase in the size of the uterus. The reproductive organ begins to displace the organs of the peritoneum. Pressure is put on them, which leads to poor circulation. The appendix is ​​adjacent to the peritoneum, and compression leads to swelling due to poor blood flow. This becomes the main cause of appendicitis during pregnancy.

Otherwise, the occurrence of acute appendicitis is associated with an increase in the production of the hormone progesterone in pregnant women. This leads to relaxation of the muscle tissue of the organs. The process causes constipation due to insufficient peristalsis of the stomach and intestines. Feces harden over time and penetrate into the large intestine. Due to the slow movement, the formed stones are able to fall into the cavity of the appendage of the cecum. This provokes blockage and causes inflammation.

Types of inflammation that occur during pregnancy

According to the form of appendicitis in pregnant women, there are 2 categories:

• catarrhal;
• destructive.

Catarrhal inflammation provokes an increase in the size of the appendix. The appendage swells, but purulent exudate does not flow beyond the appendage. In the destructive form, appendicitis is divided into subtypes.

During pregnancy, a woman develops a phlegmonous type of lesion. The appendix is ​​filled with purulent exudate. When diagnosed, you can see how the appendage is increased in size. In this case, inflammation can be complicated by peritonitis at any time.

During pregnancy, the lesion of the appendage instantly changes from phlegmonous appendicitis to a gangrenous form. The form of the disease is characterized by tissue necrosis. The death of the epithelium of the appendage provokes its perforation. This leads to the discharge of purulent exudate into the abdominal cavity.

The gangrenous type of lesion of the appendage is complicated by the perforated form. This occurs due to untimely assistance within 24 hours after the detection of primary symptoms. Inflamed exudate leaves the appendage and fills the abdominal cavity. The disease provokes the development of new inflammatory processes in other organs and the fetus.

Diagnostics

The diagnosis is made based on:

1. History. Where the pain originated, where it has shifted, changes in intensity - whether it is increasing or not. Have there been any attacks of nausea, vomiting or diarrhea?
2. Inspection. Correspondence of temperature and pulse, color of skin and mucous membranes, coating on the tongue. Presence of appendicular symptoms or signs of peritoneal inflammation.
3. Laboratory data. Dynamic monitoring of changes in blood parameters is carried out: an increase in leukocytosis (up to 15*10^9/l) and ESR (up to 45 mm/h), the appearance and increase in band leukocytes. If the indicators worsen, then this indicates the progression of the inflammatory process.
4. Ultrasound examination. It is performed using transabdominal dosed compression. They try to bring the sensor as close as possible to the area of ​​the appendix, carefully displacing the omentum and loops of the small intestine. In this case, moderate compression of the intestines occurs and gas is displaced from this area. Fluid accumulates in the inflamed appendix and the walls thicken; these signs become visible. An accurate diagnosis with transabdominal examination is made in approximately 95% of cases. During long periods of pregnancy, this study is carried out in a lying position on the left side.

   To diagnose acute appendicitis, an ultrasound examination of the abdominal cavity is performed

5. Doppler study of blood flow in the appendix. In the catarrhal form, increases in Doppler signals are observed, which indicates an increase in blood flow. In destructive forms, developing necrosis of the process, there are no signals in these altered areas.
6. Diagnostic laparoscopy. It is carried out if, according to non-invasive methods, it was not possible to make an accurate diagnosis. This method is also used to differentiate appendicitis from acute cholecystitis or pancreatitis. On laparoscopy, the inflamed appendix is ​​visible in 100% of cases.
7. Urine tests. Used for differential diagnosis with renal pathology.

What is associated with the development of inflammation of the appendage?

In addition to the enlargement of the uterus, during pregnancy, damage to the appendage occurs due to the following factors:

• impaired immunity;
• change in the position of the appendage;
• impaired blood circulation and spasm of capillaries and blood vessels;
• infectious diseases;
• constipation or frequent loose stools.

Poor nutrition in pregnant women causes inflammation of the colon, which leads to damage to the appendix. Therefore, you should not often consume dry or heavy foods.

Prevention

There are no special rules for the prevention of appendicitis in pregnant women; you just need to follow the general rules:

• lead a healthy lifestyle;
• eat properly and balanced;
• do not miss appointments with the obstetrician-gynecologist;
• promptly treat diseases that can lead to inflammation of the appendix;
• Tell your doctor about any changes in your health.

In most cases, the prognosis for appendicitis in pregnant women is favorable.

How does the disease manifest?

In pregnant women, signs of appendicitis manifest differently. During the inflammatory process there are no attacks of nausea. When intoxication of the body occurs, the urge to vomit is not observed in pregnant women. The main symptom is abdominal pain. Discomfort varies in location depending on the period of gestation.

In the first half of pregnancy, pain is characterized by a sharp manifestation in the navel area. When a woman coughs or laughs, the severity of the symptom becomes brighter. If pregnancy occurs at 4 or 6 months, then the sign appears on the right side at the level of the navel. At 7 or 9 months, discomfort from appendicitis covers the area under the ribs. Sometimes the pain migrates to the lower back from the right side.

What is the danger of acute appendicitis during pregnancy?

During the period of bearing a child, a woman should listen to the slightest changes in her own health. The reluctance of a pregnant woman to go to the doctor when possible signs of appendicitis appear will lead to dire consequences.

For a child, such an indifferent attitude is expressed in the form of oxygen starvation (hypoxia) and premature placental abruption. The baby is in danger of death due to the irresponsibility of such a mother.

The woman herself puts herself at risk of developing intestinal obstruction, an infectious and inflammatory process in the peritoneum, massive blood loss, septic shock, and other things.

If the appendix ruptures, a cesarean section is performed, regardless of the stage of pregnancy, and the uterus and fallopian tubes are removed.

Stages of development of acute appendicitis

The first stage in medicine is called catarrhal. It is characterized by inflammation of the appendix, abdominal pain (usually in the navel area), sometimes nausea and vomiting. Its duration is from 6 to 12 hours.

If the operation is not performed at this time, then complications appear in the form of the second (phlegmonous) stage, during which the tissue of the appendage is destroyed, ulcers appear and pus accumulates. Constant aching pain moves to the right side, body temperature can rise to 38°C*. This stage of acute appendicitis lasts about 12-24 hours.

Next, necrosis of the walls of the appendix occurs and its rupture - the third (gangrenous) stage. The discomfort may subside for a while, but then coughing will cause severe pain in the abdomen. The duration of the third stage of appendicitis is 24-48 hours.

The last stage is a rupture of the appendix and inflammation of the peritoneum (peritonitis) due to the contents of the appendix entering the abdominal cavity. Further, without surgical intervention, the situation ends in death for both.

* Remember, during pregnancy the normal body temperature is slightly higher than that of a non-pregnant woman, and it reaches 37.4°C (in some, up to 37.6°C).

Let us present statistics on fetal mortality due to inflammation of the appendix in the mother.

The table shows that the progression of the disease increases the risk of death of the baby.

Therefore, it will not be possible to wait and rest, and treatment with folk remedies will not help in this situation either. At the slightest suspicion of appendicitis, you should immediately consult a doctor or call an ambulance. Ignoring the symptoms will bring disastrous consequences.

If you suspect appendicitis, you should not:

• putting a heating pad on the stomach - this only accelerates the inflammatory processes, and such warmth will only cause harm to the child;
• take antispasmodics and painkillers - diagnosis is difficult, and when probed by a doctor there will not be a proper reaction;
• eat and drink something - the operation is performed on an empty stomach, otherwise the risk of complications during the operation increases.

How to provide timely assistance?

The first signs of the disease for a pregnant woman are difficult to determine. However, to make sure that the inflammatory process is progressing, you need to pay close attention to your condition and monitor your health. In a pregnant woman, the symptoms of appendicitis can be determined independently. When the body turns from left to right, the main symptom intensifies.

The pain becomes more intense if the woman lies on her right side. This involves putting pressure on the appendage. Nausea or vomiting may occur for several hours after the inflammation begins. In most cases, a disorder of the digestive tract occurs. Loose stools are accompanied by constant pain in the right side. If during pregnancy the symptoms of acute appendicitis were not identified, then signs of complications arise. The development of peritonitis is characterized by an increase in temperature. Depending on the degree of outflow of purulent exudate, bloating occurs in the abdomen, heart rate increases and shortness of breath occurs.

Due to the displacement of the appendix, pregnant women experience frequent urination. The pain syndrome is located in the perineum. Discomfort can spread or radiate to the legs.

Childbirth after appendix removal

If childbirth begins before the sutures have completely healed, then the entire process takes place under the special supervision of obstetricians, a surgeon and a neonatologist. The sutures are fixed with a bandage and complete anesthesia is given.

During childbirth, intrauterine hypoxia of the fetus is constantly prevented; a dissection of the perineum is required to reduce the time the baby passes through the birth canal, since with strong and prolonged pushing, the sutures after appendicitis may come apart.

If you have undergone surgery to remove your appendix in the early stages, the likelihood of emergencies during childbirth is minimal, but the process will still be monitored by several additional specialists.

Risk of occurrence during pregnancy

Appendicitis for pregnant women is considered a serious disease that affects the fetus. This is due to the risk of miscarriage in the last trimester. The consequences include the development of infection in the abdominal organs. Otherwise, intestinal obstruction occurs.

In rare cases, appendicitis can lead to placental abruption during pregnancy in women. This process occurs prematurely and manifests itself in complications for the child. In addition, inflammation of the membranes occurs, which leads to infection of the fetus. To save the baby, the doctor prescribes antibacterial therapy.

Complications of appendicitis

1. Peritonitis is an inflammation of the peritoneum, that is, the serous membrane covering the abdominal organs. Peritonitis develops in advanced cases of diseases (appendicitis, cholecystitis, intestinal obstruction and others) and significantly worsens the prognosis. With appendicitis, the inflammation is still local (partial and limited), it is easier to cure with less effort. With the development of peritonitis, inflammation spreads throughout the abdominal cavity, affecting other organs, and a systemic inflammatory response develops.

If peritonitis develops, the pregnant woman may be at risk of sepsis.

2. Sepsis is a pathological condition when inflammatory agents enter the blood and circulate in it. With the development of a septic condition, extended surgical measures, sanitation and drainage (installation of drainage tubes) of the abdominal cavity, and massive antibiotic therapy are indicated. In this case, the mother is saved; the prognosis for the fetus is extremely unfavorable.

3. Bacteriotoxic shock. If the process does not develop for the first day, then a complication such as bacteriotoxic shock is possible. After antibiotics are prescribed in the postoperative period, massive death of pathogenic microorganisms in the blood and accumulation of decay products occurs. This has a depressing effect on the vascular center, blood pressure drops, pulse and breathing increase. The condition is classified as emergency; without assistance, the patient will die.

4. Antenatal fetal death. A widespread inflammatory reaction, possible changes in blood pressure, disruption of uteroplacental blood flow and other factors can lead to fetal death in utero.

5. Premature abruption of a normally located placenta. This formidable complication also occurs due to the instability of the mother’s hemodynamics and systemic inflammation in her body.

6. Inflammatory complications for the fetus (placentitis during pregnancy, chorioamnionitis during childbirth and after childbirth, turbidity of amniotic fluid).

Seeing a doctor

To determine appendicitis in a pregnant woman, the help of a specialist is required. First of all, the doctor conducts an examination and collects complaints. To confirm the disease, palpation is performed. When pressing on the right side of the abdomen, the pain intensifies. The intensity changes as the doctor's hand moves away. Some forms of appendicitis are accompanied by thickening of the muscle tissue of the peritoneum.

To reliably determine the inflammatory process in pregnant women, urine and blood tests are performed. This is indicated in the results by an increased level of white blood cells. However, this indicator appears with any inflammatory process in the body. Therefore, instrumental methods are used to establish a diagnosis.

Ultrasound helps diagnose the degree of development of appendicitis in pregnant women. The study is carried out examining the abdominal cavity. In addition, the doctor determines how much the vermiform appendix has increased in size. Sometimes an ultrasound examination can reveal the abscess.

Ultrasound diagnostics helps to detect appendicitis in pregnant women in 50% of cases. Most doctors rely on ultrasound results. Therefore, laparoscopy is not often used.

Actions at the first sign

If appendicitis is suspected, you should:

• Call an ambulance;
• Record the time of pain onset;
• Refrain from eating and drinking heavily until the doctor arrives; a maximum of a glass of water is allowed;
• Do not take any medications - this will prevent an accurate diagnosis;
• While waiting for the ambulance, do not take active actions, take a lying position;
• Upon arrival of the ambulance, show the doctor your passport, insurance policy, and exchange card.

Don’t be afraid, the pregnant woman will not be taken to the maternity hospital - the inflamed appendix is ​​removed in surgery, not in gynecology. But if appendicitis occurs in the later stages, then delivery by cesarean section is acceptable where the patient is taken.

Treatment in pregnant women

When a doctor has diagnosed a woman during pregnancy, treatment is prescribed. However, for appendicitis there is only one therapy - surgery. Currently, appendicitis is removed in several ways. The intervention takes place using the classical method or using peritoneal punctures.

An appendectomy is performed by making a small skin incision on the right side of the abdomen. The operation is allowed to be used in the early stages of pregnancy. First, the surgeon examines the cecum and abdominal cavity. This allows us to exclude other diseases of the internal organs. The surgeon begins to remove the appendage. If the inflammation is complicated by an abscess, then drying is carried out initially. The procedure is applied using drainages. To allow the tissue to begin to heal, stitches are placed on the incision. They are removed after 7 days without complications.

Appendectomy is not performed in late pregnant women. This is associated with the risk of complications.

In medicine, there is a new way to remove the appendix, called laparoscopy. For this purpose, a special optical system is used. In this case, the operation in pregnant women is performed using small holes in the peritoneum. After laparoscopy, the postoperative period passes without pain. The woman recovers faster than after an appendectomy.

In addition to surgery, laparoscopy is used to determine the diagnosis. This occurs when the doctor is unable to accurately identify the disease. This method does not leave scars after surgery. Therefore, most pregnant women use it.

Consequences of surgery

After removal of appendicitis, premature termination of pregnancy occurs in 30% of cases. If labor occurs, doctors deliver the baby. However, the woman will be classified in the miscarriage group. This process occurs due to the development of peritonitis, when a purulent infection is accompanied by metastases if treatment was not carried out in a timely manner.

Sometimes premature birth after or before surgery occurs due to psycho-emotional trauma. This is often accompanied by fear and anxiety of the pregnant woman. In addition, pressure arises in the peritoneum, which affects the fetus. After removal of the appendix, reflex irritation of the uterus or damage to the reproductive organ may occur. Therefore, for pregnant women, appendicitis is removed only after consultation with a gynecologist.

When appendicitis appears in a pregnant woman, it becomes dangerous for the unborn child. A common cause of inflammation is the position of the weaker sex. Primary signs are difficult to determine. However, there is constant discomfort, regardless of body position. At the same time, the sensations increase or decrease. Therefore, appendicitis during pregnancy has consequences in the form of premature birth. This can happen both after surgery and before it.

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Additional factors contributing to the development of appendicitis

The most common causes of acute appendicitis are:

• the presence of a mechanical obstacle in the form of a fecal stone, which impedes the outflow of secretions from the appendix cavity into the cecum;
• infection of the appendix with pathogenic or conditionally pathogenic intestinal flora.

Features of the physiological state of a woman during pregnancy are:

• compression of the intestine by the enlarged uterus, displacement of the appendix and cecum outward and upward, which creates an additional obstacle to peristaltic contraction;
• forced bending and stretching of the appendix;
• changes in hormonal composition, causing a rush of blood to the placenta and a reduction in blood supply to neighboring organs;
• tendency to constipation caused by slow passage of impulses for the nervous regulation of the intestines;
• a significant decrease in the level of immunity, which contributes to the activation of microflora;
• proliferation of lymphoid tissue;
• reduced ability to limit the process of inflammation through the formation of adhesions.

All together, these reasons make a woman very vulnerable to any disease, including appendicitis. The risk increases in the second half of the term.

A reluctance to follow doctor’s recommendations and change habits during pregnancy plays a certain role:

• smoking;
• drinking alcoholic beverages;
• dry food without enough fruit and meat;
• passion for seeds and nuts;
• lack of mobility.

Excessive consumption of nuts and seeds clogs the intestines, promotes constipation and activates opportunistic microorganisms

Signs that occur in the first trimester

The vestigial organ becomes infected as it begins to grow - it becomes inflamed, pus accumulates, and the body's immune system tries to contain the spread of the infection. Appendicitis during pregnancy develops certain symptoms, duration, character, intensity of which is determined by the duration of the fetus's intrauterine stay. In the first trimester they include:

• Vague, dull pain in the upper abdomen or around the navel that lasts for several hours or days, then moves to the lower right side of the abdomen.
• Worsening of pain when moving, coughing or laughing, since tension in the abdominal muscles in this case affects the inflamed appendix.
• Loss of appetite develops - it is discovered that the last few days before the onset of signs of appendicitis are characterized by a lack of interest in food, which is extremely unusual for pregnant women.
• When the pain intensifies, the feeling of malaise, weakness, and fatigue increases.
• Digestive disorders - not being able to have a full bowel movement - is a characteristic phenomenon for the onset of appendicitis; accumulation of intestinal gases develops, forming a concomitant pathological condition – flatulence.
• Vaginal bleeding. If it is accompanied by intense cramps, the lower abdomen begins to hurt.
• Nausea occurs up to several times a day, accompanied by chills, weakness, and a woman may even experience dehydration if attacks constantly end with vomiting.
• Fever followed by the development of hyperthermic syndrome.
• Edema. This sign is difficult to identify against the general background of pregnancy.