Clinical features of acute appendicitis in pregnancy

Acute appendicitis in pregnancy can give a presentation of:

• pain above and more lateral to that usually expected, e.g. right upper quadrant, due to the shifting up of caecum and appendix by the enlarging uterus after the middle of the second trimester
• more diffuse tenderness than normally expected with appendicitis due to:
  • the gravid uterus anterior to the appendix
  • the anterior abdominal wall being displaced away from the appendix, so reducing peritonism
• minimal guarding and rigidity, due to the increased laxity of anterior abdominal wall muscles

There is a physiological leukocytosis in pregnancy and consequently, the leukocytosis of additional appendicitis may elevate white cell levels to greater than 20,000 per mm cubed.

The displacement of the appendix increases the probability of advanced inflammation, perforation, premature labour and maternal mortality. An obstetrician and surgeon should share management.