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Appendicitis in PregnancyAnatomyThe sixth week of human development the appendix and cecum develop as outpouchings of the caudal limb of the midgut loop.The fifth month the appendix elongates into its vermiform shape. At birth the appendix is located at the tip of the cecumThe adult appendix typically originates from the posteromedial wall of the cecum because of unequal elongation of the lateral wall of the cecum, caudal to the ileocecal valve. Anatomy

AnatomyThe appendix averages 9 cm in length, with its outside diameter ranging from 38 mm and its lumen ranging from 13 mm. The base of the appendix is consistently found by following the teniae coli of the colon to their confluence at the base of the cecum. The appendiceal tip, however, can vary significantly in locationAnatomy

AnatomyThe arterial supply of the appendix comes from the appendicular branch of the ileocolic artery, which originates posterior to the terminal ileum and enters the mesoappendix near the base of the appendix. Lymphatic drainage flows to lymph nodes along the ileocolic artery.

PathophysiologyClosed loop obstruction is caused by a fecalith and swelling of the mucosal and submucosal lymphoid tissue at the base of the appendixIntraluminal pressure rises as the appendiceal mucosa secretes fluid against the fixed obstructionIncreased pressure in the appendiceal wall exceeds capillary pressure and causes mucosal ischemiaLuminal bacterial overgrowth and translocation of bacteria across the appendiceal wall result in inflammation, edema, and ultimately necrosisSurgical Anatomy of Appendectomy

Appendicitis in PregnancyThe diagnosis of acute appendicitis in the pregnant patient can be particularly challengingNausea, anorexia, and abdominal pain may be symptoms of both appendicitis and normal pregnancy.The gravid uterus can displace the abdominal viscera, shifting the location of the appendix from the right lower quadrantThe differential diagnosis of appendicitis includes certain conditions specific to pregnancy: ectopic pregnancy, chorioamnionitis, preterm labor, placental abruption, and round ligament pain.Appendicitis in PregnancyIn the first and early second trimesters, the presentation of appendicitis is similar to that seen in nonpregnant women. In the third trimester, women may not present with right lower quadrant pain due to displacement of the appendix by the gravid uterusAppendicitis in PregnancyThe pregnant patient should proceed directly to appendectomy if appendicitis is suspected. A normal appendix is not an uncommon finding, as negative laparotomy has been reported in approximately one-third of cases due to the difficulty of diagnosis in this population.Negative laparotomy should not be considered an error in diagnosis, because the risk to the fetus varies directly with the severity of appendicitis. Appendicitis in PregnancyIn one series, fetal loss occurred in only 1 (3%) of 30 negative laparotomiesFetal mortality rises to 5% in cases of nonperforated appendicitis, and increases to 20% when the appendix perforatesEarly negative exploration is justified to minimize the likelihood of progression to perforation

Appendicitis in PregnancyBaer et al. emphasized the displacement of the appendix by the gravid uterus and the corresponding relocation of the pain.The performance of any operation during pregnancy carries a risk of premature labor of 10 to 15%, and the risk is similar for both negative laparotomy and appendectomy for simple appendicitisAppendicitis in Pregnancy

Appendicitis in PregnancyIn obstetrics the most frequent uses of progesterone :The treatment of threatened abortion,Prevention of recurrent miscarriageThe support of the luteal phase in assisted reproduction programmesThreatened preterm labour. Randomized, controlled trials showed that women who received progesterone were statistically significantly less likely to have recurrent miscarriages before 34 weeks.Appendicitis in PregnancyVaginally dosed progesterone is being investigated as potentially beneficial in preventingpreterm birthin women at risk for preterm birth. The initial study by Fonseca suggested that vaginal progesterone could prevent preterm birth in women with a history of preterm birth.The hormone treatment was administered vaginally every day during the second half of a pregnancy.Thank You