Appendicitis During Pregnancy: Symptoms And Treatment

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Abdominal pain is one of the many symptoms that you experience during pregnancy (1). The pain is usually caused due to the expanding uterus that stretches the tissue surrounding it.

But if you experience a sharp, throbbing pain in the lower right abdomen, it is a symptom of appendicitis, which can be life-threatening when left untreated. Appendicitis occurs in one in every 1,000 to 1,500 pregnancies (2), usually during the first two trimesters.

Here, MomJunction tells you what appendicitis is, its causes, symptoms, treatment, and care.

What Is Appendicitis?

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Appendicitis is the inflammation of the appendix, a vestigial finger-shaped organ attached to the colon. The non-functional organ is located in the lower abdominal region and is two to four inches long.

In some cases, the inflamed appendix is filled with pus, causing pain and discomfort. It is not very common during pregnancy, but when present, you should not delay visiting the doctor (2).

Appendicitis during pregnancy is usually acute and manifests in the form of pain that spreads quickly. The only treatment for this is to remove the appendix surgically.

In very rare cases, you may experience chronic appendicitis, also referred to as rumbling or grumbling appendix. It results in abdominal pain that is more of a dull ache.

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What Are The Causes Of Appendicitis During Pregnancy?

Pregnant or not, appendicitis can affect anyone anytime. The major and common causes of this condition are (3):

  • Accumulation of the feces in the appendix, causing a blockage
  • Obstruction of the appendiceal lumen (inside the appendix where mucus is created), which can occur due to external or internal factors
  • Formation of calcified fecal deposits in the appendix, which are also referred to as appendix stones
  • Presence of intestinal microbes, such as pinworms, in the digestive tract
  • Ingestion of any foreign substances such as pins, stones or bullets which may get settled in the appendix
  • Bacterial infections such as measles, salmonella or Shigella bacteria

Appendicitis can also be genetic. The risk of developing appendicitis is higher if a member of the family has suffered from it previously.

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What Are The Signs And Symptoms Of Appendicitis During Pregnancy?

Here are the symptoms you should watch out for to diagnose appendicitis (4).

  1. Abdominal pain: Abdominal pain is the classic symptom of appendicitis. If the pain you are experiencing is in the right lower quadrant of the abdomen (it is usually between the navel and pelvic bone) and becomes worse when pressure is applied in the area, see a doctor. Appendicitis pain begins as a mild throbbing and soon becomes intense, and even unbearable.
  1. Vaginal bleeding: Bleeding during pregnancy is not normal. And if you have intense pain in the lower right side of the abdomen, along with bleeding, it could be appendicitis. Light or heavy – any vaginal bleeding along with pain during pregnancy requires immediate medical attention.
  1. Nausea and vomiting: Both nausea and vomiting are common pregnancy symptoms. But if you experience them along with pain in the lower abdomen, it could be appendicitis.
  1. High fever: A high fever almost always accompanies appendicitis. If you have abdominal pain and a temperature that refuses to ease, you should call your doctor.
  1. Abdominal swelling: Sometimes, appendicitis can lead to abdominal swelling. It may not be visible to women who are in the later stages of pregnancy, but on observation and touch, you can identify this symptom.

You will also experience loss of appetite, fatigue, and constipation in some cases. However, most of these symptoms are similar to those of labor. And if you experience them in the later stages of pregnancy, they could probably be experiencing labor pains. In any case, it is best to consult the doctor.

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What Happens If Your Appendix Bursts While Pregnant?

If you neglect the condition and do not check for the symptoms, there is a risk of the appendix getting ruptured. This can further lead to serious complications, including maternal and fetal morbidity (5).

So, if you suspect appendicitis, go for a complete diagnosis immediately to avoid complications.

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How To Diagnose Appendicitis During Pregnancy?

If your doctor suspects appendicitis, she may suggest the following procedures and tests to diagnose the condition (4): –

  • Blood test to detect the white blood cell count, which usually increases in the case of appendicitis.
  • Urine test, because appendicitis could lead to urinary tract infections.
  • Imaging tests that include abdominal ultrasounds, magnetic resonance imaging (MRI) and computerized tomography (CT). They detect inflammation of appendix and obstructions that cause this condition.

If the diagnosis confirms appendicitis, the doctor will suggest the next step to take.

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Treatment For Appendicitis In Pregnant Women

Treatment options for appendicitis include:

Medications: Antibiotics to treat mild inflammation and infection. They are also given intravenously for better results (6).

Surgical intervention (laparoscopic appendectomy): If your appendix is severely inflamed or your doctor suspects perforation of the appendix, surgery will be the only way out. If you are in your first or second trimester, laparoscopic surgery will suffice. But if you are in your third trimester, you may need a larger incision (7).

An open appendectomy is an option in the third trimester since laparoscopy is difficult with the larger uterus.

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What Happens After The Appendicitis Surgery?

Your doctor will monitor the baby and check for any preterm contractions after the surgery.

However, most women do not go into premature labor because of these contractions. They successfully go on to carry their pregnancy to full term and deliver a healthy baby.

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How To Take Care After Appendectomy?

Recovery time is generally short, and you can leave the hospital a few days after the surgery (7). However, you should:

  • Avoid lifting heavy objects
  • Include a well-balanced diet
  • Follow-up with the surgeon a week or two after the procedure
  • Take complete rest, while moving around a little bit at frequent intervals.

Lack of proper care after the surgery can have a negative impact on your pregnancy.

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Does Laparoscopic Appendectomy Affect Pregnancy?

Laparoscopic appendectomy is safe and preferable with good maternal and fetal outcomes (8). However, here are a few risks and challenges associated with it.

  • Visibility is vital in case of laparoscopic surgeries, which are not ideal in the later stages of pregnancy when the growing uterus can block the view of the appendix.
  • There is a slight risk of teratogenesis until the early second trimester because of the drugs administered during the surgery. The best time for surgery, therefore, is the second trimester when the organs are completely formed and the probability of preterm birth is low. However, there is no chance to delay surgery until second trimester in the case of acute appendicitis.
  • If surgery is needed urgently, it should be performed irrespective of the gestation period. The mother’s well-being is always the priority.
  • Long-term prognosis of children born to mothers who have had an appendectomy during pregnancy is good (9).
  • There is no research to show that appendectomy incision could reopen during labor. However, if you do not seem to recover from the surgery, a C-section is indicated.

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Can You Get Pregnant After An Appendectomy?

Yes, you can get pregnant after an appendectomy. Since an appendix has no purpose in the body, its removal will not affect your fertility.

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How To Prevent Appendicitis During Pregnancy?

Though there is no surefire way to prevent the condition, certain dietary and lifestyle changes can help in reducing the risk.

  • Follow a diet rich in fiber. The dietary fiber softens the stools, allowing it to pass freely without getting trapped in the appendix. Eat high fiber foods including onions, sweet potatoes, broccoli, Brussels sprouts, chia seeds, flax hemp, psyllium seed husk, green beans, peas, mushrooms and raw almonds.
  • Drink enough water while taking the above foods.
  • Include probiotics such as kefir, yogurt, and buttermilk for a healthy supply of good bacteria for the digestive tract.
  • Indulge in mild exercises (such as brisk walking, stationary cycling, and swimming) for the body to function optimally.

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Can Appendicitis Prevent Pregnancy?

Appendicitis will not prevent pregnancy. In rare cases, it can affect a pregnancy if the fallopian tubes are damaged by the inflammation (caused by appendicitis). This can prevent the sperm from meeting the egg.

When left untreated, appendicitis during pregnancy can be a threat to both the mother and the baby. The condition can lead to severe consequences and should be addressed immediately. Since surgery is the only way to treat appendicitis, it is important to seek expert opinion to choose the right course of action and keep yourself and the baby safe.

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Do you have any experiences to share? Let us know in the comment section below.

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Dr. Burcu Saygan Karamürsel

Burcu Saygan Karamürsel is a board certified obstetrics - gynecology and maternal-fetal medicine specialist working in Ankara,Turkey. A graduate from Hacettepe University Medical School, she has also attended a fellowship programme at Bonn University Hospital, Perinatology Department. Currently, she runs her own private clinic in Ankara and contributes to several newspapers’ online health columns and websites. She is specialized in... more

Rebecca Malachi

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She has been into health and wellness writing since 2010. She received her graduate degree in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig... more