Where does appendicitis hurt in the third trimester? What symptoms indicate pathology? What diagnostic methods exist?

Expectant mothers usually associate abdominal pain with pregnancy. In most cases this is true. This is why it is possible to miss the symptoms of appendicitis during pregnancy. To prevent this from happening, you need to know how it manifests itself. insidious disease.

Appendicitis, or inflammation of the appendix, is one of the most common organ diseases abdominal cavity. Among women with appendicitis, it occurs in up to 3-3.5% of pregnant women. The incidence of acute appendicitis in pregnant women is slightly higher than in other women.

The exact causes of appendicitis are not fully known. There are several versions. According to one of them, it is believed that the development of appendicitis is directly related to blockage of the lumen between the cecum and the appendix. Blockages may occur due to the formation of small fecal stones- coprolites that close the lumen, thereby disrupting the blood supply to the appendix, which leads to its swelling and inflammatory manifestations.

Pregnancy may be a predisposing factor for the development of appendicitis. This is explained by the growth and enlargement of the uterus, which, taking up more and more space in the pelvis, compresses the appendix, disrupting its blood supply, which leads to the development of inflammation.

Symptoms of appendicitis during pregnancy

There are simple (i.e. catarrhal) and destructive (phlegmonous, gangrenous and perforated) forms of appendicitis. All of them are stages of development of a single process, and for their occurrence during the progressive course of the disease it is necessary certain time: for catarrhal appendicitis (when only the mucous membrane of the appendix is involved in the inflammation process) - 6-12 hours, for phlegmonous (changes can be traced in the mucous, submucosal and partially on the muscular layer) - 12-24 hours, for gangrenous (when the death of all layers is noted walls of the appendix) - 24-48 hours: later, perforation of the appendix may occur, in which the intestinal contents enter the abdominal cavity.

Manifestations of appendicitis largely depend on pathological changes in the appendix, as well as on its location in the abdominal cavity. As long as the inflammatory process is limited to the appendage itself, without moving to the peritoneum - the layer of connective tissue covering the walls and organs of the abdominal cavity - the manifestations of the disease do not depend on the location in the abdominal cavity relative to other organs and are expressed by pain in the upper third of the abdomen, which gradually shift down to the right half of the abdomen. This may cause nausea and vomiting. Abdominal pain can be minor and occur not only in the right iliac region, but also in other parts of the abdomen. Often, pain upon examination is not immediately detected and is detected much higher than the uterus; often the greatest pain is detected in the right lumbar region. Characteristically, the pain intensifies when lying on the right side, due to the pressure of the pregnant uterus on the inflamed area.

With further development inflammatory process pain appears in the right iliac region - in the lower abdomen or higher, up to the hypochondrium, depending on the degree of displacement of the appendix by the uterus, that is, on the duration of pregnancy. Symptoms of peritoneal irritation (pain when suddenly removing the hand pressing on the anterior abdominal wall) are absent in pregnant women or are mild due to stretching of the abdominal wall. In pregnant women, all symptoms may be mild and appear late.

Other features of appendicitis include the atypical location of the appendix. So, with a “high” location of the appendage (under the liver), symptoms of gastritis may appear with pain in the upper abdomen, nausea, and vomiting. With a “low” location (in the pelvis), especially if the process borders on bladder, a picture of cystitis - inflammation may be observed Bladder, with pain radiating to the leg, perineum, with frequent urination in small portions.

The development of appendicitis in pregnant women also affects the fetus, especially if appendicitis develops in the second trimester of pregnancy. Most a common complication pregnancy is in danger of being terminated. Other complications include postoperative infectious processes and intestinal obstruction. In rare cases, premature detachment of a normally located placenta occurs, when the placenta detaches from the wall of the uterus over a more or less extended area. In this situation, the prognosis depends on the degree of detachment - with a small detachment and timely treatment, pregnancy can be saved. Chorioamnionitis (inflammation membranes) And intrauterine infection fetuses require antibacterial therapy.

The likelihood of complications is especially high during the first week after surgery. In this regard, all patients after appendectomy are prescribed drugs that relax the muscles of the uterus. To prevent infectious complications after appendectomy in pregnant women, all patients are prescribed antibiotics.

An excursion into anatomy

The appendix (Latin appendix - “adjacent”) is a vermiform appendix. It is a hollow tube that ends blindly on one side and adjacent to the cecum on the other. In most cases, the appendix is located in the lower abdomen on the right, but quite often there are atypical forms of location of the appendix, when it can descend into the pelvis or, conversely, ascend to the liver. Such atypical forms of the location of the appendix can lead to difficulties in diagnosing its inflammation.

Diagnosis of appendicitis in pregnant women

Diagnosis begins with a thorough interview and examination. Patients often experience fever and pain (from tolerable to very severe) in the right lower abdomen, when walking or palpating (and often at rest). If the inflammation has reached the peritoneum, “rebound” pain is often observed. This means that when the doctor presses on the abdomen and then quickly removes the hand, the pain briefly increases.

If there is an infection, the number of white blood cells (leukocytes) in a blood test is increased. On early stage appendicitis, it may be normal before infection develops, but more often there is at least a slight increase in the white blood cell count. Unfortunately, appendicitis is not the only condition that causes an increase in white blood cells. Almost any infection or inflammation can lead to an increase in the number of white blood cells. Therefore, just an increase in the number of white blood cells cannot be considered as direct proof appendicitis.

There is not a single test, with the exception of laparoscopy, that can be used to diagnose appendicitis for sure.

Urine microscopy. This is an examination of urine under a microscope that can detect red blood cells, white blood cells and bacteria. The urine test is usually altered if there is inflammation or stones in the kidneys or bladder, which can sometimes be confused with appendicitis. Therefore, changes in urine indicate a pathological process in the kidneys or bladder, while normal results urine microscopy is more characteristic of appendicitis.

Ultrasonography. This is a painless procedure that uses sound waves to see the internal organs. Ultrasound examination may reveal an enlarged appendix or abscess. However, with appendicitis, the appendix is visible in only 50% of patients. Therefore, the inability to see the appendix during ultrasound does not exclude appendicitis.

Laparoscopy. This is a surgical procedure in which a thin fiber-optic tube with a camera is inserted into the abdominal cavity through a small hole in the abdominal wall. Laparoscopy allows you to see the appendix and other organs of the abdominal cavity and pelvis.

If appendicitis is detected in a pregnant woman, the appendix can be removed immediately. The operation is performed under general anesthesia or epidural anesthesia - an injection of an anesthetic into the space above the dura mater of the spinal cord, as a result of which the surgical area and legs are numbed.

There is not a single test, with the exception of laparoscopy, that can be used to diagnose appendicitis for sure. Therefore, if appendicitis is suspected, the tactics of action may be as follows. First, the patient is observed in the hospital. If 2 hours of observation do not provide complete clarity, diagnostic laparoscopy is performed or surgery, depending on the capabilities of the hospital.

Treatment of appendicitis during pregnancy

For appendicitis, the only possible surgical treatment is appendectomy. Antibiotics are started before surgical intervention, as soon as the diagnosis is made, in order to prevent postoperative suppurative complications.

Currently, two techniques are used to remove the appendix: traditional surgery, performed through an incision, and endoscopic surgery, which is done through punctures under TV control.

During an appendectomy performed through an incision, an 8-10 cm long incision is made through the skin and layers of the abdominal wall above the area where the appendix is located. The surgeon examines the appendix. After examining the area around the appendix to ensure there is no other disease in the area, the appendix is removed. If there is an abscess, it can be drained using drains (rubber tubes) that extend from the abscess and out through the incision. The incision is then sutured.

A new way to remove the appendix involves using a laparoscope, an optical system connected to a video camera that allows the surgeon to look inside the abdomen through a small puncture hole (instead of a large incision). If appendicitis is detected, the appendix is removed using special tools, which are inserted into the abdominal cavity, like a laparoscope, through small holes. Advantages of using laparoscopy for appendicitis: reduction in post-operative pain (as pain mainly arises from the incisions) and more fast recovery, as well as an excellent cosmetic effect. Another advantage of laparoscopy is that it allows the surgeon to look into the abdominal cavity and make an accurate diagnosis in cases where the diagnosis of appendicitis is in doubt. The laparoscopic method of removing the appendix is optimal method surgical treatment, especially for pregnant women.

Postoperative period

Management of pregnant women postoperative period, prevention and treatment of complications acute appendicitis are carried out according to the rules accepted in surgery, taking into account a number of features. After the operation, do not apply weights or ice to the abdomen (this can cause pregnancy complications); caution is exercised in expanding the regimen and in choosing remedies aimed at improving bowel function. Physiotherapy is used, which helps not only improve bowel function, but also helps maintain pregnancy. Antibiotics are used that cannot harm the fetus. Prevention of premature termination of pregnancy after surgery consists of maintaining bed rest for a longer period and using appropriate treatment: sedatives, with noticeable contractions of the uterus - suppositories with papaverine or magnesium sulfate, endonasal electrophoresis of vitamin B1.

After discharge from the hospital, such pregnant women are included in the risk group for the threat early termination pregnancy, which can occur in the long term after the operation, therefore it is carried out preventive actions aimed at maintaining pregnancy.

The fetus in these women is considered to have suffered an intrauterine infection and is taken necessary measures monitoring its development, the condition of the fetus and placenta - (ultrasound, hormonal studies, Doppler measurements). In case of manifestations of fetoplacental insufficiency (when the fetus does not receive enough oxygen and nutrients), the woman is hospitalized and given appropriate therapy.

Management of childbirth occurring in the early postoperative period (1-3 days after surgery) is distinguished by care. Tight bandaging of the abdomen is used (to prevent sutures from coming apart), complete anesthesia with extensive use of antispasmodics. During childbirth, intrauterine hypoxia (lack of oxygen) of the fetus is constantly prevented. The period of expulsion is shortened by dissection of the perineum, because with pushing, intra-abdominal pressure increases with load on the anterior abdominal wall, which negatively affects postoperative sutures.

No matter how far in time childbirth is from surgical intervention, it is always carried out with sufficient caution due to the tendency to complications: anomalies of labor forces, bleeding in the placenta and early postpartum periods.

Roman Shaposhnikov, surgeon, City Clinical Hospital No. 20, Moscow

Discussion

Girls, I got appendicitis at 28 weeks! I thought I was going crazy. Now I remember - it gives me goosebumps. Now I’m writing specifically to reassure you, remembering how I frantically surfed the Internet in the hospital... My dear girls, this happens often, everything will be fine! My miracle lies there smiling, everything is fine! The operation was performed abdominally, under general anesthesia. They didn’t interfere with any saves, everything was ok! Just in case, the doctor prescribed approved antibiotics to drink/inject, as there is a risk intrauterine infection. In the end, she gave birth herself two days before the baby's birth, the waters were clear. So don't worry, everything will be fine. May God protect our children!

07/28/2015 20:33:50, Vi4kaaaapp

Yes, appendicitis can take you by surprise, but can it really be removed in advance? Although I heard somewhere that in China they seem to delete early age, although if it exists, it means nature has provided for everything, okay.

The boss had her appendicitis removed during pregnancy without anesthesia at all. They gave her a stick in her teeth so she wouldn't scream too much! Her daughter is now 8 years old, so she wants to have her appendix cut out at the age of 15-18, before he gets sick at the wrong time!

Pavlinka, judging by the article, can give birth a week after the operation. The stitches heal quite quickly, after 2 months everything is fine. And the belly begins to grow at 3-4 months, so if there are risks, they are very small.
And depression must be driven out! it is much more harmful, especially for expectant mothers.

Girls, good luck with your birth and good health to your children!
As I understood from the article, it is still possible to become pregnant after surgery earlier than 6 months after the operation? I had an operation 3 weeks ago, but the fact is that the doctors did not know what it was, gynecology or appendicitis, and therefore I have 2 stitches, one between the navel and pubis 10 cm and the second on the right 3 cm. My husband and I really want to give birth and therefore would not want to interrupt our attempts to get pregnant. What do you think about it? I'm actually in a terrible mood depressed state after the operation... it’s very difficult mentally, and physically too...
Thank you!

04/18/2008 16:28:27, Pavlinka

My mother with 1st B was cut out at 8 months. Instead of anesthesia there was a hand young boy- trainee. When his mother released his hand, it was blue, but the boy did not make a sound, and that’s how they underwent the operation together!!!
Good luck and hang in there!!!

I’m very happy for you and the cub!
But I have something hurting in my right side, I’m afraid it’s appendicitis. 9 weeks pregnant, I haven’t gone to the doctor yet.

04/17/2008 14:36:48, Ekaterina

I had my appendix removed during my first pregnancy, back when I was short term. They didn’t inject me with antibiotics - I’m allergic to them. And everything is fine - the cub is 14 years old, smart, without health problems.

A friend of mine remained infertile and spent a year in hospitals. For 5 months The appendicitis was not diagnosed in time and could not be operated on properly. Of course, she also lost the child then.

Comment on the article "In a state of emergency. Appendicitis during pregnancy"

How to determine appendicitis? Health. Teenagers. Parenting and relationships with children adolescence I had this attack during pregnancy. Acute appendicitis is an inflammation of the appendix of the cecum.

Discussion

Of course, call!!! Appendicitis may even occur in hidden form up to the stage of peritonitis. By not calling an ambulance, you are risking the child's life.

You need to lie on your back and lift your leg towards you... if this is intolerable, then most likely appendicitis. It's better not to joke with him at all...

Appendicitis during pregnancy. His stomach continued to hurt, and the discharge note said “reactive pancreatitis.” we had uncontrollable vomiting, despite the fact that the stomach did not hurt, but the diagnosis was perforated purulent Intestinal colic. The doctors are great - they arrived quickly...

Acute appendicitis is an inflammation of the appendix of the caecum. Complications and signs of pregnancy and pain in the stomach and intestines: how to distinguish and what to do. Appendicitis during pregnancy. But I have something hurting in my right side, I’m afraid it’s appendicitis.

Discussion

09/04/2018 12:06:43, From me

Literally at the beginning of May, my child had a stomach ache and his T was about 37.2. At the clinic they said if you have abdominal pain, call an ambulance and let them rule out appendicitis. I foolishly called, the doctor at the ambulance said that it didn’t seem like it, but they wouldn’t take responsibility, so we went to the hospital, let the surgeon take a look and let me go if everything was okay. The surgeon in the waiting room (just in Speransky) said that she couldn’t say for sure right now, she needed to do an ultrasound and observe. They took the child and didn’t let me in. They took blood right away. The next day, the doctor said that they didn’t operate, but the child had leukocytes in his blood, so she wouldn’t let him go yet. They didn’t let me see the child, our dad went crazy and scolded me for pushing the child into the hospital. On the third day, dad decided to take the child with a signature, but they had already let him go, saying that he had nothing. His stomach continued to hurt, and the discharge note said “reactive pancreatitis.” We kept him on a diet for several days, and everything went away.
Now I will call an ambulance only as a last resort.

It hurts and stings in the right side. Ailments, diseases, toxicosis. Pregnancy and childbirth. I had this at first last pregnancy. It hurt in my side right in the area of appendicitis, however, then gradually it began to hurt on the other side.

Discussion

Ovary, posca, appendicitis. That seems to be it... it turned out to be my kidney (only in the left one), and the ovaries, due to constant low-cystic changes during pregnancy, hurt until, apparently, they stopped functioning completely. - I don’t remember anymore... but somehow only at the beginning. HEALTH!!!

It also hurt - I think the ligaments, but then it went away.

After appendicitis. The child had his appendix removed yesterday. Who went through this? During the first few days, what do we do, what do we feed? Sports during lactation. On the third day after the operation, I was jumping like a goat :-) There were problems with bumps and bruises from injections on my butt - two months passed.

Discussion

In such a situation, I would refuse further breastfeeding. not because of pumping, but because of antibiotics. or somehow manage without antibiotics. I had a sad experience with my first child - almost immediately after giving birth I had to be injected with antibiotics. I fell for it (although later it turned out that I could have endured without them). So: we are still correcting dysbacteriosis and impaired metabolism - we are already 5. The pediatrician who is now “nursing” us says that if there is a very definite need for the mother to be treated with antibiotics, then breastfeeding should be stopped - there is more harm to the child. and, by the way, I drank yoghurts, etc. that restore flora.

Of course, it’s possible, especially at 4 months, when the baby is big and sucks well.
Only you should be careful with your breasts in the hospital - express once every 2-3 hours, always at night, dress warmly so that your breasts do not catch a cold. Ask for antibiotics that are compatible with breastfeeding - then your husband or relatives will be able to take milk home - give it from a bottle.
I myself spent 3 days in the hospital at 3 months of age (suspicion of appendicitis). I pumped, one might say, everything free time. At that time, we generally had a mixed bag, and we fought for it with all our might, so after the hospital my boy took it sooooo well...:-). In general, at 3.5 we switched to full GW.

Health to you and your baby!

08/15/2005 15:34:25, Irinka_2004

Appendicitis and pregnancy. In the early stages of pregnancy (3 weeks), I underwent surgery to remove purulent appendicitis with abdominal inflammation. How often and how much discharge can there be during pregnancy? And how to treat them when their water breaks?

Discussion

girls....in short..I went for an ultrasound:((((
Aunt is kind of strange, doesn’t understand anything...:-(she said, the left ovary is greatly enlarged... the right one is somewhere almost behind the uterus.. the uterus is normal.. not like pr B.. and besides two-horned!!! I finally heard this for the first time... BUT she said on the left in the satka there is a small heterogeneity - it doesn’t look like B, but like anything can happen. Perhaps this is a very short period of time. some kind of inflammation. I’m at a loss. I don’t know what to do???
10/29/2001 15:58:05, candle

About appendicitis. . Pregnancy and childbirth. The problem is this: for a hundred years now I have been having pain in the place where the appendicitis is located. And during pregnancy too. so the doctor told me that after the birth of the child I need to undergo an examination.

Discussion

and I had the pain for about two years and was diagnosed with “chronic appendicitis,” although as this old surgeon said, such a diagnosis has not been made for a long time, and just about a year after giving birth, it suddenly became inflamed, all the signs were there, my grandmother sent me to the hospital , she is my doctor. It was very disappointing and at the wrong time, and I kept pestering the doctor during the operation, whether it was necessary or not, then he showed me this intestine and so - well, he said, I would definitely live until the morning. Actually, it was just luck. Because I just arrived from the sea, and there was no smell of doctors there. And I had signs - very high leukocytosis in the blood, and a temperature of about 37. But, they say, inflammation can be determined quite accurately from the blood.

10/25/2000 11:35:50, HMB

It’s the same thing. Now I’m pregnant and it constantly hurts, I told the doctor about it, but he says that my appendicitis is now in a completely different place (that is, it has risen to the level of the ribs). I’ll conduct an examination after the birth.

24.10.2000 22:19:26, larisonchik

Appendicitis is a disease that is characterized by an inflammatory process of the vermiform appendix (appendix) of the cecum. This complication is extremely dangerous especially in later pregnancy.

Appendicitis- one of the most common acute surgical diseases, the diagnosis of which is not difficult. Pregnant women still have difficulties making a diagnosis, since the manifestations of appendicitis are often superimposed on other changes in the body that accompany pregnancy - toxicosis, intestinal displacement and internal organs, increased gas formation and general malaise.

In modern medicine, most doctors - gynecologists and surgeons - will be able to provide assistance to such special patients as expectant mothers.

After reading this article, there is no need to be afraid. In fact, acute appendicitis is a rare occurrence among pregnant women (about 5% of cases). It is important to be especially vigilant and know the main symptoms in order to consult a doctor in time and prevent life-threatening complications.

Causes of appendicitis in pregnant women:

As a rule, appendicitis in pregnant women most often occurs at 35-38 weeks, that is, in the later stages. The thing is that the uterus, which has significantly increased in size, greatly displaces and compresses the intestines. As a result of this, the outflow of contents from the appendix is disrupted and inflammation develops.

Modern surgeons deny the influence of nutrition on the development of appendicitis. Seeds, fish bones and other foods have not been the cause of inflammation of the appendix for a long time.

Other factors contributing to the development of appendicitis:

Worm infestations- ascariasis;
Intestinal stones;
Scars on the cecum;
Neurological disorders that lead to disturbances in the innervation and functioning of the cecum and appendix;
Decreased immunity;
Eating large amounts of meat.

The listed factors and prerequisites for the development of appendicitis lead to the fact that the cecum and appendix become susceptible to infections that easily penetrate the intestinal walls. Therefore, the main (usually the only) cause of appendicitis is infection!

What forms of appendicitis occur in pregnant women?:

During pregnancy, women most often develop two forms of appendicitis:

Spicy;

Chronic, which manifests itself symptomatically during exacerbations against the background of an enlarged uterus and worsening infectious-inflammatory process in the appendix.

Other forms of the disease - gangrenous, phlegmonous - are quite rare options during pregnancy.

Signs of acute appendicitis during pregnancy:

Appendicitis and its manifestations early stages

In the first and early second trimester, the manifestations of the disease are the same as in non-pregnant women. Most characteristic symptoms:

Acute pain in the epigastric region. This department is easy to determine using the "triangle" rule. To do this, you need to draw an imaginary triangle, the base of which will pass above the navel, and the apex at the level of the ribs. The entire space that is inside the triangle is the epigastrium;
Pain in the navel area;
Pain throughout the abdominal area;
Pain in the right iliac region - the right lower abdomen on the side of the appendix. Such pain does not appear immediately, but several hours after the onset of the symptoms listed above;
Nausea;
Vomiting - one-time or repeated;
Increase in body temperature to 37-37.6⁰С;
Increased heart rate;
Gray coating on the tongue;
Dryness of the tongue and mucous membranes of the oral cavity;
Bloating;
The stomach does not participate in breathing;

A woman's condition rapidly deteriorates when acute appendicitis passes into more complex and severe forms - gangrenous or phlegmonous, as well as peritonitis. The main manifestations are as follows:

Increasing severe pain in the places listed above;
Manifestations of severe intoxication;
Increased tachycardia;
Severe increase in body temperature up to 39⁰C;
Changes in the blood picture - the number of leukocytes is greatly increased, especially the number of neutrophils increases;
This condition usually lasts for about two days.

Subsequently, the vermiform appendix breaks through - the so-called perforation of the wall occurs. A very dangerous condition develops - peritonitis - inflammation of the abdominal cavity.

Features of symptoms in late pregnancy

In the second and third trimesters of pregnancy, the location of the appendix changes significantly. The pregnant uterus moves it to the side:

Kidneys;
Gallbladder;
Ureter;
Spine.

The infected appendix is removed from the peritoneum, which minimizes the risk of inflammation in the form of peritonitis. But danger lurks on the other side - infection from an inflamed appendix can easily spread to the uterus and fetus. This process is often accompanied by contractions of the uterus, which threatens the onset of premature birth or fetal death.
The main symptoms of appendicitis in late pregnancy:

1. Pain in the lumbar region;
2. Painful sensations under the ribs on the right;
3. Rapid increase in manifestations of intoxication;
4. A rapid increase in the number of neutrophils in the blood;
5. Increase in ESR two days after the onset of the disease.

The same symptoms accompany exacerbation of chronic appendicitis in pregnant women.

What conditions can be confused with appendicitis in pregnant women?:

Most often, timely diagnosis of the disease is difficult due to the fact that appendicitis is mistakenly mistaken for the following diseases and conditions of a woman who is carrying a baby:

1. Toxicosis of pregnant women;
2. Poisoning;
3. Pancreatitis;
4. Gallstone disease (cholecystitis);
5. Urolithiasis disease;
6. Infectious diseases;
7. Ectopic pregnancy;
8. Threat of miscarriage;
9. Increased tone uterus;
10. Premature placental abruption;
11. Ovarian cyst;
12. Tumors of the abdominal organs.

How to quickly establish the correct diagnosis?:

The methods for making a diagnosis are as follows:

Medical examination;
Gathering information about the presence of symptoms;
Blood test with a formula (of interest is the number of leukocytes, neutrophils, as well as the ESR indicator);
Urinalysis to rule out infections of the woman’s urinary system;
Ultrasonography. It is carried out in the presence of a gynecologist and surgeon. Allows you to establish the correct diagnosis in a short time;
Laparoscopy. It is used in difficult cases to diagnose the disease. It is an invasive method, therefore its use as a method of diagnosis in pregnant women is extremely limited.

Treatment of appendicitis in pregnant women:

If appendicitis is inflamed, then it is impossible to deal with the disease without urgent surgical intervention, just like waiting for the baby to be born. This insidious disease will not wait. You need to act quickly and decisively.
Surgery to remove the appendix can be performed in two ways:

1. Traditional with a cut;

2. Laparoscopy. This is a minimally invasive method that involves making three small holes for inserting instruments and a laparoscope camera.

The operation is performed under anesthesia - local, general or spinal anesthesia. The method of pain relief is selected only by the anesthesiologist, taking into account many factors of the patient’s condition.

An operation to remove appendicitis is not a death sentence for a pregnant woman. Many women who had it at 32-36 weeks safely waited for the baby to be born after the 40th week.

Complications of appendicitis:

Inflammation of the appendix is fraught with the following complications:

1. Transition to more severe forms - gangrenous, phlegmonous;

2. Peritonitis - inflammation of nearby abdominal organs;

3. Premature birth;

4. Termination of pregnancy;

5. Fetal death.

The very fact of appendicitis in a pregnant woman, regardless of its form, is always an alarming condition! All products formed in a woman’s body during the infectious-inflammatory process penetrate to the fetus and can threaten its health. A diagnosis made very late often leads to the need to use strong antibacterial drugs and other medicines.

Modern medicine has reached such a level that pregnant women with appendicitis are treated without harm to the fetus or the need to cause premature birth. It is important for a woman to undergo treatment in a specialized clinic where there are obstetricians-gynecologists and surgeons. Together, they will help a woman completely get rid of the disease, carry and give birth to a baby on time.

Consequences of the operation:

Complications in the postoperative period in women expecting the birth of a baby develop much more often. These include the following:

Inflammatory processes of varying degrees;
Peritonitis;
Long-term healing of sutures;
Anemia;
Miscarriage;
Premature birth. It is important that the gynecologist prescribe medications that reduce the tone of the uterus and prevent premature birth or spontaneous abortion;
Injury to the fetus and uterus;
The need to take medications that negatively affect the fetus (including antibiotics);
The need for delivery by cesarean section and at an earlier stage.

What should pregnant women with suspected appendicitis not do?:

Every woman should understand that it is impossible to make a diagnosis on her own. When unpleasant symptoms, and even more so with their rapid increase, it is necessary to immediately call an ambulance!

Many patients seek to implement a number of measures that (in their opinion) will help relieve pain and other symptoms. Remember what is strictly prohibited to do:

1. Apply any heat to painful place;
2. Massage;
3. Take painkillers, especially very strong ones. This will greatly complicate the doctor’s work;
4. Accept any medicines, including folk or homeopathic
5. Give enemas or take laxatives;
6. Eat.

Remember, the help of a doctor is required. After all we're talking about not only about your health, but also about the safe birth of a healthy baby!

Every pregnant woman is susceptible various diseases. Among the most common diseases, modern medicine notes acute appendicitis in pregnant women. Indeed, studies have confirmed that this surgical pathology occurs in every twenty-fifth expectant mother. In principle, every woman is at risk of contracting this disease. For women in labor, appendicitis is primarily dangerous because it can cause a miscarriage.

Appendicitis is inflammation of the appendix located to the right of the pubic bone. This disease must be treated with extreme caution. It is necessary to constantly visit an obstetrician-gynecologist in order to recognize the danger in time. If this is not done, the consequences can negatively affect both the health of the fetus and the condition of the pregnant woman. The main cause of appendicitis in expectant mothers may be an enlarged uterus. It promotes displacement of the appendix and often causes circulatory problems.

Symptoms of appendicitis in pregnant women can be easily identified if you carefully monitor changes in the body. Often with this disease, unpleasant, disturbing pain appears in the right side of the abdomen. The absence of vomiting and nausea should alert expectant mothers. True, in some cases, vomiting is a sign of acute appendicitis in a pregnant woman. Timely diagnosis will help to accurately determine possible danger. The most common symptoms include:

Sharp pain in the lower abdomen, first the pain appears in the navel area, and then moves to the right and down.
Increased body temperature, dizziness.
Vomiting and nausea, but only if they are accompanied by pain in the abdominal area.
Diarrhea, diarrhea.
The desire to eat food disappears.
Frequent urination associated with inflammation of the pregnant bladder.

Be sure to pay attention to pain in the right side, especially when lying down. Signs of appendicitis in pregnant women are difficult to determine because some symptoms are considered normal in this condition. Many expectant mothers, as a rule, do not pay attention to some unpleasant pathologies that have arisen in the body. Although you should, at the slightest suspicion of illness, contact a specialist. In practice, appendicitis during pregnancy and some of its symptoms remain without due attention. Only timely medical intervention will help in accurately recognizing the disease.

It should be noted that appendicitis occurs during pregnancy, mainly in the early stages of gestation. The guideline will be the first twenty-two weeks. It is at this time that the risk of appendicitis in expectant mothers increases. If you experience noticeable pain in the abdominal area, you need to be alert. The pain may worsen over several hours. The signs must be seen in totality. For example, a rise in temperature in a pregnant woman does not necessarily mean that she has appendicitis. It’s another matter if your stomach hurts, your temperature rises, your appetite disappears, vomiting appears, loose stool. First of all, pay attention to sharp pains in the lower right side of the abdomen. This is the most basic sign of appendicitis.

Diagnosis and treatment of appendicitis in pregnant women

If appendicitis is suspected, a diagnosis should be made. The doctor asks the pregnant woman in detail about her health complaints. Inspection in progress appearance patients. Future mom, before visiting the doctor, should be in a calm state. It is important to remember that stress and anxiety will negatively affect the health of the pregnant fetus.

A complete blood count will determine the number of leukocytes. In addition, modern medicine uses for diagnosis ultrasonography. The abdominal cavity is examined with optical instruments, which are inserted through an inconspicuous incision in the anterior abdominal wall. When diagnosing a patient, a specialist must distinguish appendicitis during pregnancy from other possible diseases.

The disease can be cured through surgery. Moreover, at any stage of pregnancy, surgery is necessary. If postoperative complications occur, special medications are used that relax the muscles of the uterus. The main goal of doctors is to maintain the health of the patient and prevent miscarriage. Pregnancy after removed appendicitis should not stop.

Do not be afraid of premature birth and termination of pregnancy during surgery. In the overwhelming majority, surgeons preserve the health of the unborn child and do not harm the condition of the pregnant woman. The operation is carried out both in the conventional way and using laparoscopy. The second method is more preferable, especially for expectant mothers. It is believed that it is easier to rehabilitate after it. There are fewer postoperative complications.

Unfortunately, some difficulties may arise after the operation:

The ability of the uterus to contract is impaired, which is very important during childbirth.
Intestinal obstruction appears.
The child may not have enough oxygen.
Bleeding.
Threat of premature birth, placental abruption.
There is a risk of infection.

At traditional way To remove appendicitis, an incision is made in the abdominal cavity above the location of the appendix. The doctor makes a ten-centimeter incision and cuts out the appendix. After suturing, the operated patient usually recovers within a week. The wounds heal within a few days after the operation. When treatment occurs using a laparoscope, a puncture is made in the abdomen to excise the affected organ. Sometimes this method is not suitable. This happens if the disease has taken an acute chronic form.

After an appendectomy, a pregnant woman is prescribed a course of treatment medicines. Under no circumstances should medications cause any harm to the health of the expectant mother. First of all, they should not pose a threat to the fetus. Bed rest and application sedatives help avoid stress. Ice is applied to the abdomen after surgery for everyone undergoing surgery. But not for pregnant women! If there is contraction of the uterus, then doctors prescribe special medications such as suppositories with papaverine. In any case, after the operation it is necessary to conduct additional examination. Experts also recommend the use of various antibiotics, which are designed to improve the condition of the operated patient.

Postoperative period and prevention

Even a woman who has undergone surgery to remove her appendix is able to give birth on her own. C-section Only a doctor can recommend it if the need arises. Complications appear in the first days after surgery. The rehabilitation period includes a special regime. Particular attention is paid to the diet of the woman in labor. Nutrition should be balanced. It is forbidden to eat fatty, smoked, sour foods. It is recommended to eat fruit several times a day, but you should not overeat. Foods that contribute to the occurrence of excessive gas formation are also not recommended at first. Mashed potatoes, chicken, yoghurts can be eaten without fear. All food must be chewed thoroughly. Dishes containing fiber are beneficial.

Water must be drunk boiled. In the first month after appendix removal, pregnant women can eat:

Some sweets, honey is best
Citrus fruits, especially oranges
Various cereals
You can make herbal infusions, drink green tea
Eat low-fat dairy products

You must forget about salt, spicy dishes, herbs, and spices during recovery. Tomatoes, beans, and mayonnaise should not be consumed. Any solid food, alcohol, or carbonated drinks are also prohibited.

Long bed rest necessary for everyone after surgery. Pregnant women stand apart here. Nervous or emotional stress should also be avoided. Think about the child's future!

For prevention purposes, you should not self-heal. It's a thankless task to diagnose yourself without help. modern medicine. Gentle mode and proper diet don't get depressed and stressful situations- this is the key to the health of a pregnant woman.

Is it possible to promptly recognize appendicitis in pregnant women, the symptoms of which do not manifest themselves as usual? Why does it occur?

There are many prerequisites for the occurrence of the inflammatory process, but the main one is an enlargement of the uterus, which causes a significant displacement of the internal organs, in particular the intestines. Constant poor circulation in the peritoneal area, which gradually increases, can cause inflammatory processes not only in the appendix, but also in other organs.

There are other reasons:

decreased general immunity;
displacement of the appendix location;
appearance frequent constipation as a consequence of poor nutrition;
individual anomaly of the location of the appendix.

Localization of pain in appendicitis

The appendix is an extension of the cecum, which is considered an atavism. It does not perform any functions, does not bear the load during the digestion process, and can become inflamed and cause big problems. It is located in the lower abdomen on the right; pain during its inflammation is most often localized there, but its accurate diagnosis is sometimes quite difficult.

Despite the signs of appendicitis in women during pregnancy, it is impossible to determine the disease and make a diagnosis only from their words. Difficulties with diagnosis arise because the growing fetus gradually displaces all organs, so it is impossible to say with certainty that the pain is for this reason.

Complicating diagnosis is the fact that it may not be located in the same place in different people. In addition, at the early stage of the inflammatory process, the pain is usually diffuse in nature and its clear localization means that the situation is becoming threatening.

If we try to summarize the available information, then signs of appendicitis during pregnancy can manifest themselves in the forms described below.

According to average body measurements, the cecum may be located on the right, between the hypochondrium and the pelvis. In this case, its individual location is possible - it can be shifted towards the liver or bladder. In this regard, the pain resulting from the development of appendicitis during pregnancy, the symptoms of which are noticeable, may add additional signs. When the appendix is located above or below, this causes nausea, even vomiting, discomfort in the stomach or sensations like inflammation of the genitourinary organs. In this case, the pain may radiate to the kidney area, inguinal fold right or right thigh.
There were cases of the onset of inflammation, which made itself felt by pain on the left, gastric colic, and only as the disease progressed did the painful area shift down to the right.
You can expect a standard location of the pain area if the period is short, and as the fetus grows, it will be located higher and higher: at the level of the solar plexus or closer to the ribs.

It should be remembered that this is not necessarily appendicitis; symptoms during pregnancy, especially in the last trimester, may occur due to various reasons, for example, quite severe pain appears when increased gas formation. Such probabilities further complicate the diagnosis of appendicitis in pregnant women.

Signs of appendicitis

However, you should know the characteristic symptoms of appendicitis in pregnant women, which occurs precisely as a result of inflammation of this small appendix:

the pain continues to increase, the condition quickly worsens, the nature of the pain is colicky;
when moving, when trying to lie on the right side, the pain becomes stronger, but if you lie on your back and pull your legs towards your stomach, it weakens;
when trying to determine the development of appendicitis by pressing on the abdomen and sharply releasing it, you may not get results; in pregnant women, the expected pain does not always occur, even in the case developing inflammation;
the appearance of weakness, even fainting;
the temperature may rise, and the thermometer will show different meanings in the rectum and armpit;
Nausea and vomiting may occur, but this symptom is more often interpreted as toxicosis, especially if the period is short;
A general blood test will reveal the presence increased amount red blood cells

Since all signs of appendicitis in pregnant women, even with intense manifestations, are not specific, an examination will be prescribed.

Diagnosis of appendicitis

An accurate diagnosis can be made immediately only through examination using laparoscopy. Through a small puncture, a probe with a sensor is inserted into the suspected area of localization of the cecum to see its condition. If there are signs of developing inflammation, the appendix is immediately removed. However, this method is not available in all clinics.

Examination by laparoscopy

If there is no appropriate equipment, then if there is suspicion, the woman is placed in a hospital, where her condition is monitored. If there is a noticeable deterioration, the diagnosis is confirmed. In addition, a urine test is performed. Considering that the symptoms of appendicitis in women during pregnancy and signs of inflammatory diseases of the genitourinary system are similar, the absence of leukocytes in the urine may indicate appendicitis, their presence is a sign of bladder or kidney disease.

Ultrasound is also used to determine the condition of the cecum, but in some cases it is ineffective.

If classical methods It is not possible to determine with certainty the presence of pathology, the woman remains under medical supervision. In this case, you should not take painkillers so that the picture of the condition is clear and the signs of appendicitis in a pregnant woman enable doctors to analyze and take measures in accordance with them.

Is it possible to have surgery?

Treatment of an inflamed caecum can only be surgical, and this should not be postponed under any circumstances, since this disease poses a serious threat to life.

Removal of the appendix in the usual surgical way is performed under anesthesia, the patient is prescribed antibiotics that will cause minimal harm to the mother and child. This is necessary to prevent inflammation after surgery, as well as to prevent infection of the fetus.

Therapy during recovery period includes vitamins, medications that help normalize blood flow and good intestinal function. Medications are also recommended to maintain the tone of the uterine muscles and prevent cramps. Bed rest is usually prescribed.

The expectant mother who had to undergo surgery will be under the supervision of a doctor until the end of the pregnancy, since there is a risk of premature birth.

If surgery was performed in last weeks pregnancy, then enhanced monitoring of the condition of the expectant mother and fetus is carried out, as well as particularly careful monitoring of birth process. This is explained by the fact that when pushing, the surgical sutures may come apart.

The danger of inflammation of the appendix

Such a pathology occurs quite often during pregnancy, about 5% of women different dates are faced with this problem. Therefore, there is no need to be afraid, the main thing is to seek help if pain occurs.

Under no circumstances should you self-medicate, take painkillers, or postpone a visit to the clinic. The occurrence of colic or nagging pain may mean incipient appendicitis during pregnancy, the consequences for the child can be tragic. Therefore, it is better to play it safe.

There is some risk of exposure to medications that a woman will have to take before and after surgery, but the risk of using these medications is much lower than the consequences of peritonitis, which will begin if the inflamed appendix is not removed in time. In this case, the woman may die.

Therefore, if the doctor is not sure that the cause of the pain lies elsewhere, he has to decide on his own responsibility whether to prescribe an operation.

A particularly dangerous situation arises if a pregnant woman experiences acute appendicitis, in which case the lack of emergency measures within a short time can even lead to death.

However, an uncomplicated form of appendicitis occurs more often, in more than half of women. At the end of the period of bearing a child, the risk of developing pathology is higher; inflammation can take a severe form, for example, phlegmonous, which will turn into peritonitis.

The degree of risk differs at different periods, but there are sad statistics:

in uncomplicated form spontaneous interruption pregnancies or unsuccessful births occur in 15% of cases;
the transition of appendicitis to peritonitis, in 30% of cases ends in fetal death. This is a consequence general condition women with the development of peritonitis, in which normal interaction with the fetus and its supply of oxygen becomes impossible.

Possible complications that may arise at any time:

loss of a child;
early delivery;
various complications after surgery;
acute intestinal obstruction;
dysfunction of the uterine muscles;
lack of oxygen in the blood, which can lead to fetal hypoxia;
Bleeding may appear after childbirth.

Most high risk emergence negative consequences present in the first few days after surgery.

Conclusion

If you experience pain, weakness, or nausea, you should not attribute everything to toxicosis. At an early stage, signs of appendicitis may be similar to the usual minor ailments of a pregnant woman, so it is better to check with your doctor.

The prevalence of acute appendicitis in pregnant women is 5% of women. Most often it occurs in the 2nd trimester (more than half of all cases), less often in the first and third (20 and 15%, respectively), in postpartum period– up to 8%.

The onset of the disease is characterized by blurred signs, which makes it difficult timely diagnosis pathology. Prolonged lack of treatment and the development of a purulent process poses a great threat to the life of the mother and fetus. Since treatment is carried out only surgical method, then in the postoperative period there is big risk development of complications.

Features of appendicitis in pregnant women

Due to the atypical location of the cecal appendage, the usual clinical picture appendicitis during pregnancy changes, starting from the second half of pregnancy. Even with the usual localization of the appendix, pregnant women often experience vague symptoms of the disease. Therefore, when characteristic features listed below, you should seek immediate medical attention.

It is most often possible to finally establish the diagnosis and the need for surgery in a hospital only a few hours after hospitalization. The earlier the disease is detected and treated, the more favorable the prognosis for mother and child.

Symptoms

In the first 3 months of pregnancy, the symptoms of appendicitis do not differ from those in non-pregnant women. The only difficulty is differential diagnosis with toxicosis. In the 2nd and 3rd trimester, the cecum moves up and back, and the uterus covers it. As a result, the appendix cannot be felt, the pain is not as intense, and its location changes. As the uterus enlarges, pain on palpation is detected only in half of the cases. Increased level leukocytes in the blood for pregnant women is also physiological phenomenon, which makes it difficult to timely identify the disease.

Displacement of the appendix during pregnancy

After the 12th week of pregnancy are detected following features painful sensations:

Sudden onset of pain.
The character is cutting and constant.
Gradual movement to the right iliac region (after 1-3 hours).
Strengthening when lying on the right side and when bending the right leg towards the stomach.
Appears when pushing along the left edge of the uterus from the opposite side.
Weakness when lying on the left side due to the uterus not pressing on the appendix.
Worsened by coughing.

A sign of acute appendicitis in pregnant women is also a “symptom of referred pain.” To determine it, the woman lies on her back (in the first half of pregnancy) or on her left side (in the second half). If you press on the right iliac region, then as a result of the reflex transmission of nerve impulses from the inflamed cecum, pain is felt in the uterus, in the navel (above and below it) and in the left iliac region.

The protective tension of the muscles in the abdominal area in pregnant women is not as pronounced (especially in the later stages) as is usually the case, since the abdominal muscle fibers are greatly stretched. The appearance of this symptom in 90% of cases indicates a destructive course of appendicitis and the development of peritonitis, which entails a great danger to life.

Palpation of the abdomen is carried out in a lying position on the left side. This ensures a shift of the uterus to the left and the opening of part of the intestine with the cecum. To distinguish between uterine tension and abdominal muscle tension, the doctor massages the fundus of the uterus with his fingertips, causing it to contract periodically.

There are also classic symptoms of appendicitis that occur in both pregnant and non-pregnant women:

increased heart rate;
temperature rise to 37-38 degrees;
a large difference between the temperature measured rectally and under the arms;
nausea;
dry mouth;
vomit.

In the first half of pregnancy, pain may radiate to bottom part abdomen or lower back, at a later stage - in the right hypochondrium. Since the disease in late pregnancy is characterized by a low-symptomatic onset, the appearance of classic signs of appendicitis may signal that the woman is already experiencing complications.

Correct diagnosis of appendicitis is very important, since unjustified surgical intervention in the early stages threatens termination of pregnancy, and in the later stages - premature birth. In this regard, it is necessary to carefully monitor your own condition during the period of bearing a child.

The above symptoms are also characteristic of other diseases: inflammation of the renal pelvis, gall bladder. Therefore, additional instrumental examinations are carried out: ultrasound of the abdominal cavity and pelvic organs, laparoscopy. The last method is the most informative and is used in cases where the diagnosis cannot be established by other means, in the 1st and 2nd trimesters of pregnancy. Laparoscopy allows you to visualize the appendix in any location and determine the best surgical approach.

Consequences for mother and fetus

Acute appendicitis during pregnancy is dangerous condition threatening the life of the mother and fetus. The number of deaths in pregnant women is 10 times higher than the mortality rate in other categories of patients. Postoperative complications also occur in cases where surgical intervention was performed on time.

Since many pregnant women mistake pain during acute appendicitis for a “normal” manifestation of pregnancy, late diagnosis is typical for this disease. About a quarter of patients are admitted to surgical departments only 2 days after the onset of the disease, and the level diagnostic errors reaches 40%. Appendicitis is especially difficult to diagnose in the last weeks before childbirth, since the fundus of the uterus rises to the hypochondrium and covers most of the abdomen for examination. As a result, the development of peritonitis in the later stages in pregnant women occurs 5-6 times more often. Serious complications of appendicitis during pregnancy are also severe intoxication of the woman and fetal death. With an uncomplicated course of the disease, fetal death occurs in 8-10% of cases, and with a complicated course it reaches 50%.

In the postoperative period, a third of patients experience premature termination of pregnancy. All women who have undergone surgery to remove the appendix are at risk for miscarriage. The risk of miscarriage is highest in the first week after surgery. The following consequences are also noted in the postoperative period:

placental abruption;
fetal infection;
inflammation of the inner or outer membrane of the fetus.

Premature birth after surgery can occur for the following reasons:

development of purulent infection with metastases due to untimely treatment;
the resulting psycho-emotional trauma, strong anxiety and fear of the patient;
increased pressure inside the abdominal cavity;
reflex irritation of the uterus due to surgery;
damage to the uterus during surgery.

Surgery and its effect on the child

Treatment of acute appendicitis at any stage of pregnancy is carried out only by surgery. In the 1st trimester, an incision is made along an oblique line in the right iliac fossa, parallel to the inguinal ligament, pain relief is carried out using local anesthesia. In later stages of pregnancy, tissue dissection is performed in the place where the greatest pain is observed, taking into account ultrasound and laparoscopy data. In this case, general anesthesia is used. The operation is performed using muscle relaxants - substances that reduce the tone of skeletal muscles, and artificial ventilation to ensure sufficient oxygen saturation of the fetus.

In acute destructive appendicitis with complications (peritonitis, formation of an abscess in the abdominal cavity, inflammation of the veins, sepsis), as well as in cases where immediate delivery is necessary, a midline incision is made. If a pregnant woman develops peritonitis or severe intoxication, the woman is placed in the intensive care unit, where intensive therapy is carried out. In case of an uncomplicated course of the disease, discharge is made 7-10 days after surgery, if there are no symptoms of a threat of miscarriage.

After surgery, the following medications are used to restore the condition:

Sedatives (sodium and potassium bromides).
Painkillers: opioid analgesic Promedol for the first 1-3 days, then non-narcotic drugs.
Antispasmodics (No-spa, magnesium sulfate, rectal suppositories with papaverine).
Antibiotics of the penicillin and cephalosporin series.
Duphaston, Utrozhestan or Ginipral if there is a threat of miscarriage.
Vitamins.

Greatest bad influence the fetus is affected by a disruption of its blood supply, oxygen starvation during the operation, the influence of general anesthesia and intrauterine infection of the fetus. And if artificial ventilation Lungs during surgery allows you to solve the problem with hypoxia, but with anesthetics the situation is more complicated.

Almost all drugs used in anesthesiology penetrate the placenta and have a depressing effect on the fetus. But the lack of pain relief can lead to premature onset labor activity in a pregnant woman. For a child, the factor of prematurity has no less negative significance (immaturity of the neurological status, development of many pathologies). Therefore, anesthesia in all cases is carried out not only for the comfort of the pregnant woman, but also to reduce the risk of premature birth and preserve the health of the newborn baby. With uncomplicated appendicitis, the risk of developing pathologies for the child is minimal, most children are born healthy.