Appendicitis in Pregnancy – Causes, Symptoms & Treatment

As soon as you discover you will be a mother, the baby’s health becomes the most important thing in your life. Pregnancy is not the most comfortable of times, and great care is required to ensure your baby remains healthy and free of any ailments. Among some common problems that pregnant women face is appendicitis, which occurs due to the inflammation of the appendix during pregnancy. While appendicitis can be a painful condition, it is not an incurable one. Appendicitis is common among people of all ages so it can be treated and cured easily. However, pregnancy sometimes complicates the process, so if you’re diagnosed with appendicitis while pregnant, it must be tackled with utmost care and concern.

What is Appendicitis?

The appendix is a vestigial organ- meaning that it has no function or use in the human body- which is present in the lower abdomen area. The appendix is all that remains of the tail, which was gradually shed with evolution. It is also found to house beneficial bacteria, which can aid in the digestion of food in the stomach. The vestigial organ appendix is increasingly susceptible to inflammation, resulting in appendicitis. The inflamed appendix is also filled with pus and causes some real pain to the mother. The condition is not often seen in pregnant women, but it poses a real risk to the mother’s health and, consequently, the baby’s. Any niggling discomforts must be sorted out by the mother-to-be, so you must pay a visit to the doctor if you think that you have the condition.

Is It Normal to Have Appendicitis When Pregnant?

It is common for pregnant women to develop appendicitis, although it is considered relatively rare. While the exact cause of appendicitis during pregnancy is not well understood, it is believed to be linked to hormonal changes and increased pressure on the abdomen as the pregnancy progresses. Recognising the symptoms of appendicitis can be challenging during pregnancy, as some common signs, such as abdominal pain and nausea, can also be attributed to normal pregnancy discomfort. The incidence rates of appendicitis in pregnant women are as follows:

1. 19–36% in the first trimester, 
2. 27–60% in the second, and 
3. 15–33% in the third.

Even though statistics from several sources indicate that appendicitis is more common in the second trimester, some research indicated that 59% of cases occurred in the third trimester.

So, suppose a pregnant woman experiences persistent and worsening abdominal pain, particularly on the right side. In that case, it is crucial to seek medical attention promptly to prevent potential complications, such as a ruptured appendix, which can harm both the mother and the baby. The surgical approach may vary depending on the severity of the condition and the stage of pregnancy to balance the mother’s well-being and the safety of the unborn child.

Causes of Appendicitis

Appendicitis can affect people of any age, ranging from children to the aged. Although the condition is not often observed in pregnant women, it can still strike during pregnancy. Some of the common causes of appendicitis are:

• the blockage of the appendiceal lumen, or the surface, caused by various internal or external factors.
• the accumulation of faecal matter in the appendix, causing a blockage.
• the presence of intestinal parasites, like pinworms, in the digestive system.
• the presence of calcified faecal deposits in the appendix, also known as appendix stones.
• ingestion of foreign objects, like bullets, pins or stones, lodged in the vestigial organ.
• infection due to some disease-proliferating bacteria, like salmonella, measles or Shigella bacteria.
• Enlarged lymph nodes in the abdominal region can potentially compress or obstruct the appendix, leading to appendicitis. 
• Hormonal changes during pregnancy may contribute to an increased risk of appendicitis by altering the normal functioning of the appendix or its surrounding tissues.
• During pregnancy, there is an increased blood flow to the pelvic region to support the growing foetus. This enhanced blood circulation can increase susceptibility to infections, including appendicitis.

The role of genetics in the contraction of appendicitis must also be considered, as it was found that the risk of appendicitis in those with appendicitis in the family is almost three times higher than in a person without any family history.

Appendicitis Symptoms During Pregnancy

Symptoms can help you alleviate your fears about disease and better understand the ailment affecting you. The most commonly observed symptoms of appendicitis in pregnant women are:

1. Pain in the Abdomen: The main symptom associated with an inflamed appendix is pain in the abdominal area, which is seen not only in pregnant women. The appendix is in the lower right area of your abdomen, so the pain is usually in that quadrant of your body. The pain starts small and light and builds up with time. It becomes unbearable towards the end and may even increase if pressure is applied to the area.

2. Vaginal Bleeding: Bleeding through the vagina is scary, especially for pregnant women. If the bleeding, be it light or heavy, is combined with abdominal pain, you should rush to the hospital.

3. Nausea and Vomiting: These might be common symptoms, but when combined with the pain in the right side of the abdomen, they might indicate appendicitis.

4. Fever and swelling: High fever and swelling in the abdominal area might indicate appendicitis.

5. Loss of appetite: In case of loss of appetite, it is recommended to see a doctor because it may be a pain of appendicitis

6. Fatigue and a feeling of sickness.

7. Constipation: Constipation or other problems with digestion is also a significant cause of appendicitis.

8. Increased Abdominal Tenderness: Pregnant women with appendicitis may experience heightened tenderness or sensitivity in the abdomen. This increased tenderness can be an important indicator of appendicitis and should be evaluated by a healthcare professional.

9. Changes in Foetal Movement: Appendicitis can affect the movement patterns of the developing foetus. Pregnant women may notice a decrease in foetal movement or changes in the usual activity level of their baby due to appendicitis.

10. Back Pain: In some cases of appendicitis during pregnancy, women may experience lower back pain in addition to or instead of abdominal pain. This back pain can be persistent and may radiate from the lower back to the buttocks or legs. 

Diagnosis

The above symptoms might all indicate appendicitis, so any mother with doubt should consult the doctor quickly. Diagnosing appendicitis is tricky, and the treatment is usually even trickier. Here are some methods employed to identify it:

• Blood work is initially done to determine the number of white blood cells in the person. Appendicitis increases the number of WBCs in the bloodstream.
• A urine test is also done since appendicitis can result in a urinary tract infection in the person.
• An ultrasound Scan, the easiest imaging option to carry out during pregnancy, is done to confirm that the condition is appendicitis.
• If the Ultrasound Scan results are inconclusive, an MRI Scan is carried out. It also carries no risk or radiation, even to pregnant women.
• If the ultrasound scan results are inconclusive or if further clarification is needed, a CT scan may be conducted. This imaging technique provides detailed cross-sectional images of the abdomen, allowing healthcare professionals to visualise the appendix and assess for signs of inflammation or infection. 
• In addition to laboratory tests and imaging, doctors rely on clinical observation and physical examination to diagnose appendicitis in women. They carefully assess the patient’s symptoms, such as abdominal pain, tenderness, and rigidity, and perform a thorough physical examination to check for signs of inflammation or infection. This includes assessing the patient’s vital signs, such as temperature, heart rate, and blood pressure, which may indicate the presence of appendicitis.

What if Appendix Bursts in Pregnancy?

The rupture of the appendix can cause real complications during pregnancy, and many pregnant women have died due to the rupture of their appendix. Therefore, it is wiser to remove the normal appendix in cases where appendicitis is suspected rather than waiting for the disease to proliferate.

Necessary Preparations Before Treatment

Before the treatment of appendicitis during pregnancy, there are several necessary preparations that healthcare providers will undertake to ensure the well-being of both the mother and the unborn child. These preparations include:

1. Medical Evaluation and Assessment

The healthcare team should conduct a thorough medical evaluation, including a detailed medical history, physical examination, and possibly additional diagnostic tests. This evaluation aims to confirm the diagnosis of appendicitis, assess the severity of the condition, and determine the appropriate course of treatment.

2. Consultation With Specialists

Depending on the specific circumstances, healthcare providers must consult with various specialists, such as obstetricians, surgeons, and anaesthesiologists, to discuss the best approach for managing appendicitis during pregnancy. These consultations ensure a comprehensive assessment of the situation and help make informed decisions regarding the treatment plan.

3. Anaesthetic Considerations

When planning for surgical intervention, anaesthetic considerations are crucial. Anaesthesiologists should evaluate the pregnant woman’s overall health, including any pre-existing medical conditions or allergies, to determine the safest anaesthetic approach. They will also consider the stage of pregnancy and any potential risks to the mother and foetus.

4. Foetal Monitoring

Throughout the treatment process, it is important to monitor the well-being of the developing foetus. Healthcare providers should perform ultrasounds and use foetal heart rate monitoring to assess the baby’s condition before, during, and after the procedure. This monitoring helps ensure the foetus tolerates the treatment and remains healthy.

5. Careful Surgical Planning

If surgery is required, the healthcare team should carefully plan the procedure to minimise risks and optimise outcomes. The timing of surgery, the choice of surgical technique, and the positioning of the pregnant woman during the operation are considered to ensure the safety of both the mother and the baby.

Treatment for Appendicitis in Pregnant Women

Depending upon their condition, two methods exist for treating appendicitis in pregnant women. These are:

1. Antibiotics:  This is done only if the inflammation is mild and not bad enough to warrant an invasive procedure. The antibiotics may be administered intravenously for better results.

2. Appendectomy: It refers to the surgical removal of the appendix during pregnancy. The procedure can be done through a keyhole surgery if the mother is in the first or second trimester, but for women in the third trimester, a larger incision is required to ensure no lasting damage.

What Are the Treatment Options for Perforated Appendix During Pregnancy?

The treatment options for a perforated appendix during pregnancy depend on the severity of the condition and the stage of pregnancy. When the appendix has ruptured or perforated, immediate medical intervention is necessary to prevent complications and protect the health of both the mother and the unborn child. In most cases, surgical intervention is the primary treatment for a perforated appendix during pregnancy. The specific surgical approach can vary based on the severity of the condition, the gestational age, and the preferences of the healthcare team. The three main surgical options are:

1. Surgical intervention:

• Appendectomy (open or laparoscopic)
• Drainage of abscess if present

2. Administration of antibiotics to combat infection.

3. Close monitoring and follow-up appointments to assess healing and monitor the well-being of the mother and baby.

What Are the Possible Risks of Getting Appendicitis During Pregnancy?

Appendicitis during pregnancy can present certain risks and complications for the mother and the developing foetus. Here are some possible risks associated with appendicitis during pregnancy:

1. Delayed Diagnosis: Diagnosing appendicitis in pregnant women can be challenging because the symptoms, such as abdominal pain and nausea, are also common in pregnancy. Delayed diagnosis may increase the risk of complications.

2. Perforation: If left untreated, the inflamed appendix can eventually rupture or perforate. This can lead to the spread of infection throughout the abdominal cavity, resulting in a condition called peritonitis. Peritonitis can be severe and potentially life-threatening for the mother and the baby.

3. Premature Labour: Inflammation and infection caused by appendicitis can stimulate uterine contractions, potentially leading to premature labour. Premature birth carries its risks for the baby, including respiratory distress, developmental issues, and other complications.

4. Foetal Complications: In severe cases, if the mother develops complications, such as peritonitis, sepsis, or organ failure, it can indirectly affect the foetus. Maternal illness can lead to inadequate blood supply and oxygen to the baby, potentially resulting in foetal distress, growth restriction, or stillbirth.

5. Surgical Risks: The treatment for appendicitis typically involves surgical removal of the inflamed appendix (appendectomy). Surgery during pregnancy carries inherent risks, such as the potential for preterm labour, anaesthesia-related complications, and injury to nearby structures.

6. Infection Control: Postoperative infections, though rare, can occur after an appendectomy. Infections can be especially concerning during pregnancy as they can affect the mother’s health and increase the risk of complications for the foetus.

What Happens After the Surgery?

The mother is expected not to do any stressful activities and rest for some time after the surgery. The mark monitors the baby’s response, and it is observed that most women undergo preterm contractions after appendectomy during pregnancy. However, this does not usually result in preterm labour.

FAQs

1. Does Having Appendicitis Increase the Risk of Miscarriage?

Appendicitis itself does not directly increase the risk of miscarriage. However, if appendicitis is left untreated and complications like infection or peritonitis occur, it can affect the pregnancy and potentially increase the risk of miscarriage. Prompt diagnosis and appropriate treatment are essential to minimise the risk of complications.

2. Can the Removal of the Appendix Influence Pregnancy?

In general, removing the appendix (appendectomy) does not significantly influence a woman’s ability to conceive or have a successful pregnancy in the future. The appendix is not directly involved in reproductive processes. After recovery from an appendectomy, most women can continue with their plans for pregnancy without any issues.

3. Where Is the Appendix Located in a Pregnant Woman?

Appendix location during pregnancy is generally the same as in a non-pregnant individual. The appendix is a small, finger-shaped organ in the lower right quadrant of the abdomen. However, as the uterus expands during pregnancy, it may push against surrounding organs, potentially causing the appendix to shift slightly. This positional change can make diagnosing appendicitis more challenging, as the symptoms may be atypical or masked by pregnancy-related discomfort. If there are concerns about appendicitis during pregnancy, it is important to consult a healthcare professional for proper evaluation and diagnosis.

The relationship between appendicitis and pregnant women is unusual, but it can still occur. The condition can have dire consequences if left untreated, so it is better to get an expert opinion if you even have a slight doubt regarding the symptoms.

References/Resources:

1. Pastore. PA, Loomis. DM, Sauret. J; Appendicitis in Pregnancy; JABFM; https://www.jabfm.org/content/19/6/621; November 2006

2. Symptoms & Causes of Appendicitis; National Insitute of Diabetes and Digestive and Kidney Diseases; https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis/symptoms-causes

3. Duque. G. A, Mohney. S; Appendicitis in Pregnancy; NIH; https://www.ncbi.nlm.nih.gov/books/NBK551642/; August 2022

4. Carstens. A. K, Fensby. L, Penninga. L; Nonoperative Treatment of Appendicitis during Pregnancy in a Remote Area; AJP Reports; PubMed Central; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830160/; February 2018

5. Aggenbach. L, Zeeman. G. G, Cantineau. A. E. P; Impact of appendicitis during pregnancy: No delay in accurate diagnosis and treatment; International Journal of Surgery ScienceDirect; https://www.sciencedirect.com/science/article/pii/S1743919115000436; March 2015

6. Elraiyah. T, Hashim. Y, Elamin. M; The effect of appendectomy in future tubal infertility and ectopic pregnancy: a systematic review and meta-analysis; PubMed Central; https://pubmed.ncbi.nlm.nih.gov/25303785/; August 2014

7. About Appendicitus; Fertilitypeda; https://fertilitypedia.org/edu/diagnoses/appendicitis

Also read:

Stomach Pain in Pregnancy
Round Ligament Pain During Pregnancy
E. Coli (Escherichia Coli) when Pregnant