Acute Appendicitis In Pregnant Women Research Articles

The diagnostic value of systemic inflammation indices in pregnant women with acute appendicitis and their relationship with the duration of hospital stay

Aim: Physiological and anatomical changes occurring during pregnancy can complicate the diagnosis of acute appendicitis (AA). This study aimed to evaluate the diagnostic performance of systemic inflammation indices in distinguishing AA in pregnant women and to assess their relationship with hospital stay duration. Material and Methods: This retrospective study encompassed 32 pregnant patients who underwent appendectomy and 32 healthy pregnant (control group). Systemic inflammation indices were calculated based on neutrophil (N), platelet (P), and lymphocyte (L) levels as follows: The neutrophil-to-lymphocyte ratio (NLR) = N/L; the platelet-to-lymphocyte ratio (PLR) = P/L; systemic immune-inflammation index (SII) = (N×P)/L. Results: The AA group had higher median levels of PLR (30.9 vs. 22.4, p = 0.035), NLR (6.1 vs. 3.5, p < 0.001), and SII (1370 vs. 807, p < 0.001) compared to the control group. Systemic inflammation indices showed a positive correlation with the Alvarado score and the length of hospital stay. SII values demonstrated superior diagnostic performance in predicting AA compared to NLR and PLR values. The threshold value for SII in predicting AA was identified as >1316, with a sensitivity of 85.8% and a specificity of 72.5%. Conclusions: Systemic inflammation indices, particularly SII, demonstrate strong diagnostic value in distinguishing AA in pregnant women. SII demonstrated superior accuracy over NLR and PLR, correlating with both the Alvarado score and hospital stay, suggesting its utility as a diagnostic and prognostic marker.

INCIDENCE OF CONVERSION TO OPEN APPENDECTOMY FROM LAPAROSCOPIC APPENDECTOMY IN PREGNANT FEMALES

Acute appendicitis is a common non-obstetric indication for surgery in pregnant women, and the choice between laparoscopic and open appendectomy remains a subject of debate. While the benefits of laparoscopic appendectomy over open surgery are well-established in the non-pregnant population, consensus is lacking in the pregnant cohort. This study aims to contribute insights into the optimal surgical approach for acute appendicitis in pregnant women. The study, conducted from January 2020 to December 2022 at Nishtar Hospital, Multan, focused on 45 pregnant women presenting with abdominal pain and diagnosed with acute appendicitis. Two patients were discharged after magnetic resonance imaging (MRI) revealed a normal appendix. Of the remaining 43 cases, 27 were in the first trimester, 8 in the second trimester, and 8 in the third trimester. All patients underwent successful laparoscopic appendectomy without any conversion to open surgery. The laparoscopic procedure duration ranged from 50 to 80 minutes, with an average postoperative hospital stay of 1.5-3 days. Postoperative wound infection occurred in three patients (6.66%), and two patients (4.44%) experienced preterm labor. Fetal outcomes, assessed through Apgar grading, size, and weight, showed no notable abnormalities after birth. Laparoscopic appendectomy, regardless of gestational age, proves generally safe and suitable for pregnant women with acute appendicitis. The procedure has minimal complications, making it a viable and preferred option during pregnancy. These findings advocate for the continued consideration of laparoscopic appendectomy as a standard approach for managing acute appendicitis in pregnant patients.

The Role of Magnetic Resonance Pulse Sequences in the Diagnosis of Acute Appendicitis in Pregnant Women.

Acute appendicitis (AA) is one of the most common surgical emergencies, with a lifetime risk estimated at 7-8%. Pregnant women with appendicitis can have a difficult diagnosis becausemany signs and symptoms could overlap with other causes of acute abdominal pain. Although magnetic resonance imaging (MRI) is not contraindicated at all gestational ages for units with a field strength of three Tesla or less, there is still much discussion regarding the best protocol to follow in order to minimize survey time and maximize diagnostic efficiency. The purpose of this study was to assess how well different MR pulse sequences can diagnose AA. This retrospective study involved 179 pregnant females. All patients treated and admitted to the University Medical Center, Ho Chi Minh City, Vietnam, between January 2016 and October 2023 had their MR scans and medical data examined. MRI results were assessed and compared with surgical and histopathological findings. The mean age of the population was 29.7 ± 4.8 years (range, 18-46 years). On T1-weighted (T1W) and T2-weighted (T2W) sequences, the appendix was clearly visualized at rates of 81.8% and 89.9%, respectively. The sensitivity and specificity of the T2W in diagnosing AA were 93.5% and 92.3%, and when combined with T1W and diffusion-weighted (DW) images, the sensitivity and specificity further increased, being 96.8% and 94.9%, respectively. The predictive value of non-AA of the T1 bright appendix sign was 95.6%. Our study supports the use of MRI as an imaging test to identify appendicitis during pregnancy, as it has been shown to be a useful method for diagnosing the condition in pregnant women. The T2W pulse sequence is a useful tool for diagnosing appendicitis because of its high sensitivity and specificity. When identifying appendicitis from T2W alone proves challenging, T1W with the T1 bright sign and DW to take advantage of the appendix lumen and/or wall's diffusion features can yield additional information and boost diagnostic confidence.

Utilizing the MRI findings to diagnose acute appendicitis in pregnant women

Aims: To assess the performance of magnetic resonance ımaging (MRI ) scale for the diagnosis of acute appendicitis in pregnant women and to determine the added diagnostic value of MRI imaging.
 Methods: In this retrospective study, the data of patients who presented to our hospital emergency department between January 2018 and December 2021, had clinical and laboratory findings consistent with acute appendicitis, and were diagnosed with radiological imaging, were extracted from the hospital automation system and used for statistical analysis. Ultrasound (US) was used as the first-line diagnostic method for pregnant patients, and magnetic resonance imaging (MRI) was used as the second-line diagnostic method. The success of US and MRI examinations in diagnosing acute appendicitis was evaluated. In MRI examinations, the mean values of appendix diameter and wall thickness parameters were examined, and the sensitivity, specificity, positive predictive value, and negative predictive value of periappendiceal fat tissue intensity increase, T2A lumen hyperintensity, and periappendiceal fluid parameters were evaluated. Additionally, the frequency of acute appendicitis according to trimesters was examined. SPSS v20.0 (IBM SPSS Statistics for Windows, Version 20.0; Armonk, NY, USA) package program was used for the analysis.
 Results: When the medical records of 200 patients diagnosed with appandicitis were retrospectively examined, it was determined that there were 13 pregnant cases diagnosed with MRI during this period. Sensitivity, specificity, positive predictive value, and negative predictive value were evaluated for parameters including intraluminal T2A hyperintensity, wall thickness, periappendiceal fluid accumulation, and periappendiceal fatty tissue intensity increase. İntraluminal T2A hyperintensity and also periappendiceal fatty tissue intensity increase parameter sensitivity was 100%, however the wall thickness parameter had a sensitivity of 60% and the periappendiceal fluid accumulation parameter had a sensitivity of 80%. the periappendiceal fatty tissue intensity increase parameter had a a specificity of 33.3%, which is the lowest ratio among the other parameters. there was also no significant difference in the frequency of acute appendicitis according to trimesters 
 Conclusion: MRI examination has a high success rate and can be used as the primary diagnostic method for pregnant appandicitis cases. In terms of parameter evaluation, the highest positive predictive value (90.9%) is found by the parameter of intraluminal T2 hyperintensity, and the parameter of periappendiceal fluid collection is found to be in the second place. The success of T2A lumen hyperintensity and periappendiceal fat tissue intensity increase parameters, especially in excluding negative cases, was found to be quite high.

Using MRI appendicitis scale and DWI for the diagnosis of acute appendicitis in pregnant women.

To assess the performance of MRI scale for the diagnosis of acute appendicitis in pregnant women and to determine the added diagnostic value of diffusion-weighted imaging (DWI). From January 2018 to December 2020, 80 patients were included. All MRI were performed with a 1.5-Tesla scanner with anterior array body coil. This analysis included (1) T2-weighted imaging (T2WI), (2) fat-saturated T2WI, and (3) DWI. Two radiologists blinded to the diagnosis recorded their assessment of four findings: appendiceal diameter, appendiceal wall thickness, luminal mucus, and periappendiceal inflammation. The MRI scale of acute appendicitis which ranged from 0 to 4 was determined from these factors. An additional one point was added to the MRI appendicitis scale in those patients with evidence of appendiceal restricted diffusion on DWI. The diagnostic values and predictive factors were computed. Multivariate analysis demonstrated that the calculated MRI appendicitis scale was a significant independent predictor of acute appendicitis with a sensitivity of 96.6%, specificity of 90.2%, and PPV of 84.8%. The odds ratio of appendicitis is increased by 22.3 times for every increase in one point on the MRI appendicitis scale. Therefore, the addition of one point for restricted diffusion in the appendix on DWI imaging can add substantial value, both positive and negative predictive value, towards making an accurate diagnosis of acute appendicitis. MRI appendicitis scale is an objective and significant independent predictive factor for acute appendicitis in pregnant women. Incorporation of diffusion weighted imaging to MRI can improve diagnosis of acute appendicitis. MRI appendicitis scale is an objective and significant independent predictor of acute appendicitis in pregnant women. Incorporation of DWI/ADC map to MRI examinations can improve diagnosis of acute appendicitis in pregnant women. • MRI appendicitis scale is an objective and significant independent predictive factor for acute appendicitis in pregnant women. • The odds ratio of appendicitis can be increased by 22.3 times for every increase of one unit in MRI scale. • Incorporation of diffusion-weighted imaging to MRI examinations can add value to the scale (4.2 ± 0.7 vs. 0.7 ± 1.1; p < 0.001) among pregnant women with appendicitis versus pregnant women without appendicitis.

Clinical Characteristics of Acute Appendicitis in Pregnancy: 10-Year Experience at a Single Institution in South Korea.

Acute appendicitis is the most common cause of non-obstetric surgical disease in pregnant women. The diagnosis and treatment of appendicitis during pregnancy are very important because it can cause life-threatening morbidity to the fetus and mother. We evaluated the clinical characteristics of acute appendicitis in pregnant women. We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis at our hospital from January 2013 through December 2022. We compared non-pregnant women of reproductive age with pregnant women. We classified the pregnant women according to gestational age. A total of 828 patients were reproductive-aged women between 15 and 44 years old. There were 759 non-pregnant patients and 69 pregnant patients. ASA (American Society of Anesthesiologists) physical status classes were significantly higher and hospital stays were significantly longer in the pregnant group. There was no significant intergroup difference in terms of the proportions of complicated appendicitis, extended surgery, or complications. When the enrolled pregnant women were divided into three subgroups according to gestational age, the mean operation time was longest in the third-trimester subgroup. There were no differences among the subgroups in terms of the proportions of complicated appendicitis, extended surgery, or complications, nor were there differences among the subgroups in terms of laboratory findings. Preterm labor and stillbirth occurred in two pregnant women with complicated appendicitis in the second trimester. Immediate surgical treatment should be strongly considered in pregnant women with appendicitis. Efforts for more accurate diagnosis are needed for pregnant women with appendicitis.

Does one of the two most commonly used scoring systems have a decisive advantage over the other in diagnosing acute appendicitis in pregnant women?

This study aimed to compare the accuracy and reliability of Alvarado Score (AS) and Appendicitis Inflammatory Response Score (AIRS) in pregnant women undergoing surgery for acute appendicitis (AA). The files of 53 pregnant women with a diagnosis of AA who underwent surgery in our clinic between February 2014 and December 2018 were examined retrospectively. The patients were divided into 3 groups as follows: first trimester between 0 and 14 weeks, second trimester between 15 and 28 weeks, and third trimester between 29 and 42 weeks. The AS and AIRS values were calculated according to preoperative physical examination and laboratory results. The mean age of the patients was 28.58 (18-44) years. According to the pathology results, appendicitis was detected in 16 of 23 patients in the first trimester, in 22 of 25 patients in the second trimester, and in 2 of 5 patients in the third trimester. The AIRS was ≥ 9 in 9 patients and the AS was ≥ 7 in 19 of the 23 patients in the 1st trimester, while the AIRS was ≥ 9 in 11 patients and the AS was ≥ 7 in 19 of the 25 patients in the 2nd trimester. However, in the 3rd trimester, the AIRS was ≥ 9 in 2 patients and AS was ≥ 7 in 4 of the 5 patients. In conclusion, when the data obtained from the present study were evaluated, it was determined that both AS and AIRS are effective methods for diagnosing AA in pregnant women.

Diagnostic performance of magnetic resonance imaging for diagnosing acute appendicitis during pregnancy.

This retrospective study evaluated the diagnostic efficacy of magnetic resonance imaging (MRI) for identifying acute appendicitis during pregnancy. This retrospective study enrolled a total of 46 pregnant patients with clinically suspected acute appendicitis who underwent 1.5 T MRI and received a final pathological diagnosis. We evaluated the imaging characteristics associated with patients diagnosed with acute appendicitis, including the appendix diameter, the appendix wall thickness, intra-appendiceal fluid collection, and peri-appendiceal fat infiltration. A bright appendix on T1-weighted 3-dimensional imaging was identified as a negative sign for appendicitis. Peri-appendiceal fat infiltration had the highest specificity of 97.1% for diagnosing acute appendicitis, whereas increasing appendiceal diameter had the highest sensitivity of 91.7%. The cut-off values for increasing appendiceal diameter and appendiceal wall thickness were 6.55 mm and 2.7 mm, respectively. Using these cut-off values, appendiceal diameter had a sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of 91.7%, 91.2%, 78.4%, and 96.9%, respectively, whereas these values for appendiceal wall thickness were 75.0%, 91.2%, 75.0%, and 91.2%. The combination of increasing appendiceal diameter and appendiceal wall thickness resulted in an area under the receiver operating characteristic curve value of 0.958 with Se, Sp, PPV, and NPV values of 75.0%, 100.0%, 100.0%, and 91.9%, respectively. All five MRI signs examined in this study had significant diagnostic value for detecting acute appendicitis during pregnancy, with p-values <0.01. The combined use of increasing appendiceal diameter and appendiceal wall thickness displayed the excellent ability to diagnose acute appendicitis in pregnant women.

Laparoscopic appendectomy for acute appendicitis in pregnancy

The review is devoted to the role of laparoscopic appendectomy in surgical management of acute appendicitis in pregnancy. We analyzed reviews, prospective and retrospective studies in the PubMed, Google, the Springer Link online library, the Cochrane Systematic Review databases. The results of laparoscopic and traditional treatment of acute appendicitis in pregnant women were assessed. We analyzed clinical, epidemiological features in these patients, differential diagnosis of acute appendicitis in pregnant women, indications and contraindications for endoscopic treatment, features of laparoscopic procedures. Comparative assessment of laparoscopic and open surgeries for acute appendicitis in pregnant women was carried out. We also estimated the influence of surgical treatment of acute appendicitis on subsequent course of pregnancy.

Accuracy of Point-of-care Ultrasound in Diagnosing Acute Appendicitis During Pregnancy.

Acute appendicitis is the most common non-obstetrical surgical emergency in pregnancy. Ultrasound is the imaging tool of choice, but its use is complicated due to anatomical changes during pregnancy and depends on the clinician's expertise. In this study, our aim was to investigate the diagnostic accuracy of point-of-care ultrasound (POCUS) in suspected appendicitis in pregnant women. We conducted a retrospective analysis of all pregnant women undergoing POCUS for suspected appendicitis between June 2010-June 2020 in a tertiary emergency department. The primary outcome was to establish sensitivity, specificity, and likelihood ratios of POCUS in diagnosing acute appendicitis, overall and for each trimester. We used histology of the appendix as the reference standard in case of surgery. If appendectomy was not performed, the clinical course until childbirth was used to rule out appendicitis. If the patients underwent magnetic resonance imaging (MRI), we compared readings to POCUS. A total of 61 women were included in the study, of whom 34 (55.7%) underwent appendectomy and in 30 (49.2%) an acute appendicitis was histopathologically confirmed. Sensitivity of POCUS was 66.7% (confidence interval [CI] 95% 47.1-82.7), specificity 96.8% (CI 95% 83.3-99.9), and positive likelihood ratio 20.7. Performance of POCUS was comparable in all trimesters, with highest sensitivity in the first trimester (72.7%). The MRI reading showed a sensitivity of 84.6% and a specificity of 100%. In the four negative appendectomies a MRI was not performed. Point-of-care ultrasound showed a high specificity and positive likelihood ratio in diagnosing acute appendicitis in pregnant women in all trimesters with suspected appendicitis. In negative (or inconclusive) cases further imaging as MRI could be helpful to avoid negative appendectomy.

Acute appendicitis in pregnancy; A single center experience

Objective&#x0D; Appendicitis is the most common cause of extrauterine acute abdomen during pregnancy. There are scoring systems, such as Alvarado, based on physical examination and laboratory values developed for the diagnosis of appendicitis in the general population. However, when it comes to pregnant women, the effectiveness of the methods used in daily practice decreases considerably. In our study, we aimed to share the data of our patients who were diagnosed with acute appendicitis during pregnancy in our clinic.&#x0D; Material methods&#x0D; Pregnant women who were operated for acute appendicitis between April 2008 and May 2021 were included in the study. Demographic data of the patients, gestational week, physical examination and laboratory values at the time of admission, USG findings, type of surgery performed, surgical findings, pathology results and fetal-maternal complications that developed during postoperative follow -up were reviewed retrospectively through the hospital system.&#x0D; Results &#x0D; From the clinicopathological features of the patients, only re-operation due to appendiceal stump leakage (p:0.04) and drain placement during operation (p:0.046) were significantly associated with miscarriage. Although complications and abortion rates were higher in patients with perforation and periappendicular abscess, the difference was not statistically significant.&#x0D; Conclusion&#x0D; Detailed history and physical examination are key for the diagnosis of acute appendicitis in pregnant women. Any patient with right lower quadrant pain, nausea, vomiting and fever, who has tenderness and defensive rebound in the right lower quadrant on physical examination should be considered as appendicitis after obstetric causes are excluded, until proven otherwise.

Acute appendicitis in pregnant women: A Tunisian center experience.

Acute appendicitis is the most common surgical pathology during pregnancy. It occurs in about 1 in 500 to 1 in 635 pregnancies per year,[1] and appendectomy is the gold standard in the treatment approach.[2] However, its diagnosis represents a challenge to both surgeons and obstetrician-gynecologists. In addition, the role of laparoscopy remains controversial.This study discusses the diagnostic approach and reviews the appropriate surgical approach while evaluating the part of laparoscopy.This is a retrospective descriptive analysis reviewing 36 patients who underwent surgery for acute appendicitis during pregnancy at the “Surgery Department of Jendouba Hospital from January 1, 2005 to December 31, 2019. Data include age, comorbidities, previous abdominal surgery, symptoms, physical examination findings, complementary exams results, operative treatment details, the emergency status of the procedure, associated medical treatment, antibiotics and tocolysis, the pathology reports, and follow-up.The mean age of patients was 27 years. Twenty-one patients (58, 33%) were in the second trimester of pregnancy, 6 patients (16, 66 %) were in the first trimester, and 9 (25%) in the third one. The physical examination reported a right iliac fossa tenderness in 27 patients (75%). The abdominal ultrasound was performed in all cases and guided the diagnosis in 24 cases (66, 66%). 18 patients (50%) underwent laparoscopy, 12 patients (33, 33%) underwent laparotomy. The remaining 6 patients (16, 66%) required a conversion from laparoscopic to open surgery.The clinical presentation of appendicitis in pregnancy is often misguiding. Therefore, an abdominal ultrasound should be performed for all pregnant patients having abdominal pain. The difficulty of operating under laparoscopy increases with the pregnancy term, leading to a higher risk of conversion, which increases the operating time and the doses of anesthetics, causing a maternal and fetal risk.

Результати діагностики гострого апендициту у вагітних

The purpose of the study was to evaluate the diagnostic effectiveness of clinical symptoms of acute appendicitis in non-pregnant and pregnant women at different stages of gestation. Materials and methods. 124 patients with a diagnosis of acute appendicitis were examined. All patients were divided into 2 groups. The first group consisted of pregnant women of different gestational ages, the second group – comparison group consisted of non-pregnant women. The informativeness of such symptoms as Kocher-Volkovich, Rovzing, Bartomier-Michelson, Sitkovsky, Gabay, Brando, Michelson, Ivanov has been studied. Results and discussion. Pain syndrome was noted in all examined women of groups 1 and 2. The localization of pain in women of group 1 was varied and depended on the term of pregnancy. Most often the pain was observed in the epigastrium, followed by dislocation in the right iliac region. There was a significant decrease in the manifestations of such migration with each subsequent trimester. From the second half of pregnancy, pain in acute appendicitis was more often localized in the upper abdomen, namely in the right mesogastric region. There was a tendency to increase the frequency of pain in the right hypochondrium with increasing gestational age. In a small number of women, the pain was not clearly localized, was less pronounced. Pain in the lower abdomen, namely in the pubic and right groin areas was observed in isolated cases and only in early pregnancy. In women of group 2 in most cases the localization of pain was observed in the epigastrium with subsequent migration to the right iliac region. All symptoms had different qualitative characteristics. For non-pregnant women, the most informative were the symptoms of Kocher-Volkovich, Rovzing, in particular, their characteristics such as accuracy, sensitivity and efficiency, the level of which significantly exceeded the corresponding values in pregnant women. The diagnostic efficacy of symptoms such as Bartomier-Michelson and Sitkovsky was significantly higher in the group of pregnant women. The frequency of symptoms of acute appendicitis, which are characteristic of the pregnancy of Brando, Michelson and Ivanov, was maximal in the second trimester. Conclusion. Thus, the pain was accompanied by acute appendicitis in all women of both groups. The location of pain in pregnant women varied depending on the gestational age. Significant are specific clinical symptoms: Bartomier-Michelson, Sitkovsky, Brando, Michelson, Ivanov in the correct diagnosis of acute appendicitis in pregnant women. They should be considered as characteristic symptoms of acute appendicitis during pregnancy

Оцінка ефективності відеолапароскопічної апендектомії у вагітних

The purpose of the study is to assess the efficiency results of treatment of acute appendicitis in pregnant women by using laparoscopy at different periods of gestation on the basis of studying the effect of increased intra-abdominal pressure due to carbon dioxide pneumoperitoneum on the course of pregnancy, the state of the uterus and fetus, as well as improving the technique of performing the operation. Materials and methods. 73 pregnant women with acute appendicitis were examined. The average age of the surveyed was 25.9±0.7 years, ranged from 17 to 42 years. The gestation period ranged from 4-5 to 37-39 weeks. There were 26 (35.6%) pregnant women in the first trimester, 32 (43.8%) – in the second trimester, and 15 (20.5%) – in the third trimester. The intervention was performed using the Olympus OTV-SC endoscopic complex. Pneumoperitoneum with CO2 was created about 10-12 mm Hg. In all women, the parameters of body temperature and blood pressure were studied, and the postoperative restoration of the motor-evacuation function of the gastrointestinal tract was assessed. Laboratory research included the study of individual indicators of the leukocyte formula, changes in the hemostasis system and microbial contamination of tissues of trocar wounds. The results of the effect of increased intra-abdominal pressure during laparoscopy on the state of the fetus and uterus in the early postoperative period were assessed using the BMT-9141 (Germany) and FM-7 (England) fetal monitor in women with a gestational age of 32 - 39 weeks. Results and discussion. The study showed that laparoscopy is possible with good results in the treatment of acute appendicitis in pregnant women in the first, second and third trimesters but with few exceptions. The technical features of performing laparoscopy in pregnant women are associated with the increased size of the uterus during the development of pregnancy. When substantiating therapeutic measures for endoscopic interventions based on the study and assessment of signs of systemic inflammatory response syndrome like temperature reaction, individual indicators of leukocyte count, peripheral hemodynamics, as well as restoration of dysfunctions of the gastrointestinal tract, the revealed advantages of laparoscopic appendectomy. Removal of the appendix from the abdominal cavity in plastic containers reduced microbial contamination of wounds, leading to a decrease in the number of postoperative complications. Conclusion. Laparoscopic interventions are effective in acute appendicitis in pregnant women. They provide a mild intoxication syndrome, rapid physical rehabilitation of patients. Their advantages are the reduction of manifestations of uterus and fetal disorders, rapid postoperative recovery of gastrointestinal tract functions

Diagnostic accuracy of ultrasound in diagnosing acute appendicitis in pregnancy: a systematic review and meta-analysis.

Lack of timely diagnosis of acute appendicitis (AA) can lead to perforation and peritonitis, which might be associated with complications such as miscarriage, preterm delivery, fetal loss, and even maternal mortality. The aim of the present systematic review and meta-analysis was to evaluate the accuracy of ultrasonography (US) for diagnosing AA in pregnant patients. We performed the present systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Using a pre-designed standard datasheet, the two authors summarized the data of each study independently. Pregnant women with diagnosed or suspected AA, who have undergone ultrasonography, as well as using CT scan or surgery as the standard method, were included. A total of 8 studies consisting of 1593 patients were included. The main analysis showed that the overall sensitivity and specificity were 77.6% and 75.3% for US in diagnosing AA in pregnancy. The sensitivity of US in the first, second, and third trimesters of pregnancy were 69%, 63%, and 51%, respectively. While the corresponding figures for specificity were 85%, 85%, and 65%. There was a significant difference in the diagnostic performance of US between the first two trimesters and the third one. The DORs in these three trimesters were 36, 26, and 1.92, respectively. Ultrasound evaluation showed a low diagnostic accuracy for acute appendicitis in pregnant women, especially during the third trimester. These patients should be diagnosed early and accurately to prevent both complications and unnecessary operations. It can be recommended to consider alternative imaging, mostly after negative or uncertain US.

Potential of ultrasound in the evaluation of acute appendicitis during pregnancy: a systematic review and meta-analysis

Objective: To assess the accuracy of ultrasound in diagnosing acute appendicitis in pregnant women. Mechanism: The National Library of Medicine (MEDLINE, 1990–2020), Excerpta Medica Database (EMBASE,1946–2020) and the Cochrane Controlled Trials Register (CENTRAL) were used to extract articles that were published in English. A total of five studies involving 521 patients were selected. The DerSimonian and Laird random-effects model and Quality Assessment Tool for Diagnostic Accuracy (QUADAS-2) were used to analyze the data. Findings in brief: We identified 140 related articles and included 5 articles enrolling 521 patients. The values obtained using ultrasound for appendicitis during pregnancy were sensitivity of 0.62 (95% Confidence interval (CI): 0.43–0.78), the specificity of 0.91 (95% CI: 0.74–0.97), and the Positive Likelihood Ratio of 7.0 (95% CI: 2.5–19.7), the Negative Likelihood Ratio of 0.41 (95% CI: 0.27–0.63) and the Diagnostic Odds Ratio of 17 (95% CI : 6–49). Conclusion: Ultrasound had medium-level sensitivity and high specificity for the diagnosis of appendicitis in pregnant women.

Diagnostic Performance of Magnetic Resonance Imaging for Detection of Acute Appendicitis in Pregnant Women; a Systematic Review and Meta-Analysis.

The diagnosis of acute appendicitis (AA) in pregnant women is commonly challenging owing to the normal results of laboratory tests, organ displacement, and normal physiological inflammatory alterations. This meta-analysis aimed to investigate the accuracy of magnetic resonance imaging (MRI) in diagnosis of AA in pregnant women. Two investigators independently performed a comprehensive systematic literature search of electronic databases including MEDLINE, Cochrane Central, EMBASE, Web of Science, Scopus, and Google Scholar to identify studies that reported accuracy of MRI for diagnosis of AA in pregnant women from inception to April 1, 2022. Our systematic search identified a total of 525 published papers. Finally, a total of 26 papers were included in the meta-analysis. The pooled sensitivity and specificity of MRI in diagnosis of AA in pregnant women were 0.92 (95% CI: 0.88-0.95) and 0.98 (95% CI 0.97-0.98), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 29.52 (95% CI: 21.90-39.81) and 0.10 (95% CI: 0.04-0.25), respectively. The area under hierarchical summary receiver operating characteristic (HSROC) curve indicated that the accuracy of MRI for diagnosis of AA in pregnant women is 99%. This meta-analysis showed that MRI has high sensitivity, specificity, and accuracy for diagnosis of AA in pregnant women and can be used as a first-line imaging modality for suspected cases of AA during pregnancy. Furthermore, it should be noted that when the result of ultrasonography is inconclusive, the use of MRI can reduce unnecessary appendectomy in pregnant patients.

Four Cases of Laparoscopic Appendectomy for Acute Appendicitis in Pregnant Women

Four Cases of Laparoscopic Appendectomy for Acute Appendicitis in Pregnant Women

Case controlled study on diagnostic predictive value of inflammatory markers of complete blood count in pregnant women with acute appendicitis

The aim of this study is to evaluate and compare the diagnostic ability of platelet-related parameters and white cell-based parameters in pregnant women with appendicitis. This is a retrospective case-controlled study. Women aged between 18 and 50-years-old who had undergone appendectomy between January 2010 and January 2021 were enrolled in the study. Age, pathological diagnosis and relevant laboratory parameters were recorded for each patient. Gestational characteristics were recorded for pregnant patients. There were 58 pregnant and 1171 non-pregnant women enrolled. Pregnant women with acute appendicitis were significantly younger (p < .0001, d= −0.532), had significantly lower PLT (p = .002, d= −0.428) and ALC (p = .033, d= −.304) levels but had significantly higher MPV (p = .004, d = .415) levels than non-pregnant counterparts. In pregnant women, only MPV was the independent predictor of acute appendicitis (OR: 1,952). MPV cut-off value of 9,6 fL provided 63,5% sensitivity, 67,7% specificity, 94,2% PPV and 17,3% NPV whereas 10 fL provided 55,8% sensitivity, 100% specificity, 100% PPV and 21,4% NPV for acute appendicitis in pregnant women. Therefore, MPV might be useful for diagnosing acute appendicitis in pregnant women. Impact statement What is already known on this subject? In pregnant women, counts and percentages of white blood cells and neutrophils are known to be independent predictors of acute appendicitis. Meanwhile, physiologic leukocytosis of gestation is a challenge for interpretation of these parameters. Platelets and related markers are, as well, predictive for inflammatory processes in the human body. What do the results of this study add? The role of platelet-related markers in the diagnosis of acute appendicitis in pregnant women has not been studied previously. The results of the present study indicate that in pregnant women, changes in mean platelet volume might be an independent predictor of acute appendicitis. What are the implications of these findings for clinical practice and/or further research? Further similar large-scale case-controlled or cohort studies are required to validate the present results. In pregnant women with abdominal pain, the use of mean platelet volume as a biomarker could reduce negative laparotomy rates. A mean platelet volume is a useful tool for diagnosing acute appendicitis in pregnant women and provides helpful guidance for clinicians dealing with these patients in the emergency room.

The diagnostic role of hemogram parameters in pregnant appendicitis.

Acute appendicitis is the most frequently encountered non-obstetric disease requiring surgical intervention during pregnancy. Early diagnosis reduces maternal and fetal morbidity / mortality rates. This study aims to investigate hemogram parameters in the diagnosis of acute appendicitis in pregnant women. A retrospective case-controlled study was conducted in three groups. Thirty-nine pregnant patients with acute appendicitis (Group A), 39 fertile nonpregnant patients with acute appendicitis (Group B), and 39 healthy pregnant women (Group C) were included in the study. WBC, neutrophil count, lymphocyte count, NLR, PLR, MPV and RDW values were compared. The mean NLR values in group A, group B and group C were 7.39 (1.58-46.6), 5.66 (1-20) and 4.23 (1.54-10.77) respectively, and there was a significant difference in NLR values between the groups (P= 0.002). The mean PLR values in group A, group B and group C were 159.09 (69.1-574), 134.28 (21.5-360) and 120 (68.7-334) and difference was statistically significant (P= 0.019). Cutoff points for WBC count was 14155 106/μL (51,3% sensitivity, 82,1% specificity), for neutrophil count is 10955 106/μL (53,8% sensitivity, 84,6% specificity), for NLR is 9.23 (46,2% sensitivity, 92,3% specificity) and PLR is 157,6 (51,3% sensitivity and 82,1% specificity) NLR had largest area under the curve with 0.667 NLR. Neutrophil count, WBC and PLR were found to be the most valuable inflammatory parameters however, RDW, Lymphocyte count, and MPV levels are not found valuable markers in terms of sensitivity and specificity in the diagnosis of acute appendicitis in pregnant patients by this study.