Surgery to remove appendicitis during pregnancy. How is the postoperative period after the removal of appendicitis in pregnant women? How to manage the period after the operation

Every pregnant woman is subject to 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 getting this disease. For women in labor, appendicitis is primarily dangerous because it can provoke a miscarriage.

Appendicitis is an 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 reason for the appearance of appendicitis in expectant mothers may be an increase in the uterus. It contributes to the displacement of the appendix and often causes circulatory disorders.

Symptoms of appendicitis in pregnant women can be easily identified if you carefully monitor changes in the body. Often with this disease, unpleasant, disturbing pains appear 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 establish possible danger. The most common symptoms include:

• Sharp pains in the lower abdomen, first the pains appear in the navel area, and then shift to the right and down.
• Increased body temperature, dizziness.
• Vomiting and nausea, but only if they are accompanied by pain in the abdomen.
• Diarrhea, diarrhoea.
• Loss of desire to eat.
• Frequent urination associated with inflammation Bladder pregnant.

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 for the reason that some symptoms are considered normal in this condition. Many future mothers, as a rule, do not pay attention to some unpleasant pathologies that have arisen in the body. Although it should, at the slightest suspicion of a disease, contact a specialist. In practice, appendicitis during pregnancy and some of its signs remain without due attention. Only timely medical intervention will help in the accurate recognition of the disease.

It should be noted that appendicitis occurs during pregnancy, mainly in the early stages of gestation. The first twenty-two weeks will be the benchmark. It is at this time that the risk of appendicitis in expectant mothers is increased. If there are tangible pains in the abdomen, you need to be alert. The pain may get worse over several hours. Signs should be seen in the aggregate. For example, a fever in a pregnant woman does not necessarily mean that she has appendicitis. Another thing is if the stomach hurts, the temperature has risen, the appetite has disappeared, vomiting has appeared, liquid 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 female patients. The expectant mother, before visiting the doctor, should be in a calm state. It is important to remember that stress and excitement will negatively affect the health of the fetus.

A general blood test 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 with surgery. At what at any stage of pregnancy operation is necessary. If postoperative complications occur, then special medications are used that relax the muscles of the uterus. The main goal of doctors is to preserve the health of the patient, as well as to prevent miscarriage. Pregnancy after an removed appendicitis should not stop.

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

Unfortunately, after the operation, some difficulties may arise:

• The ability of the uterus to contract is impaired, which is very important during childbirth.
• There is intestinal obstruction.
• The child may not get enough oxygen.
• Bleeding.
• The threat of premature birth, placental abruption.
• There is a risk of infection.

At traditional way removal of appendicitis, a dissection of the abdominal cavity is made over the location of the appendix. The doctor makes an incision equal to ten centimeters and cuts out the process. After suturing, the operated woman usually recovers within a week. Wounds heal a few days after the operation. When treatment occurs with the help of a laparoscope, a puncture is made in the abdomen in order 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. In no case 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 to avoid stress. Ice on the abdomen after the operation is applied to all operated patients. But not for pregnant women! If there is a contraction of the uterus, then doctors prescribe special preparations such as suppositories with papaverine. In any case, after the operation it is necessary to conduct an additional examination. Specialists 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 an operation to remove the appendix is ​​able to give birth on her own. C-section only a doctor can recommend, if necessary. Complications appear in the first days after the operation. The rehabilitation period includes a special regimen. Special attention given to the mother's diet. Nutrition must be balanced. It is forbidden to eat fatty, smoked, sour dishes. It is recommended to eat fruits, several times a day, but you can not overeat. Food contributing to the occurrence of abundant gas formation, at first, is also not recommended. Mashed potatoes, chicken meat, yoghurts - you can eat without fear. All food must be thoroughly chewed. Useful foods containing fiber.

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

• Some sweets, honey is the best
• Citrus fruits, especially oranges
• Various cereals
• You can make herbal decoctions, drink green tea
• There are dairy products, low fat

About salt, spicy dishes, spices, spices - you need to forget for the recovery time. Tomatoes, beans, mayonnaise should not be consumed. Also prohibited is any solid food, alcohol, carbonated drinks.

Long bed rest everyone needs after the operation. Pregnant women stand apart here. You should also avoid nervous or emotional overstrain. Think about the future of the child!

In order to prevent it, you should not engage in self-healing. 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 the pregnant woman.

Is it possible to recognize appendicitis in pregnant women in a timely manner, the symptoms of which do not manifest themselves as usual? Why does it arise?

There are many prerequisites for the occurrence of an inflammatory process, but the main one is an increase in the uterus, which causes a significant displacement internal organs in particular the intestines. A permanent violation of blood circulation in the peritoneum, which gradually increases, can cause inflammatory processes not only in the appendix, but also in other organs.

The reasons are different:

• decrease in general immunity;
• displacement of the location of the appendix;
• appearance frequent constipation as a result of malnutrition;
• an individual anomaly in the location of the appendix.

Localization of pain in appendicitis

The appendix is ​​a process of the caecum, which is considered an atavism. It does not perform any functions, does not carry a load in the process of digestion, while it can become inflamed and cause big problems. It is located in the lower abdomen on the right, the pain during its inflammation is most often localized there, but its exact 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, since the growing fetus gradually displaces all organs, so it is impossible to say with certainty that the pain is for this reason.

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

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

• According to the average physique, the blind process can be located on the right, between the hypochondrium and the pelvis. At the same time, its individual location is possible - it can be displaced in the direction of the liver or bladder. In this regard, in addition to the pain resulting from the fact that appendicitis develops during pregnancy, the symptoms of which are noticeable, may be added additional signs. When the appendix is ​​located higher or lower, it is nausea, even vomiting, discomfort in the stomach or sensations, as with inflammation of the urinary 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 with pain on the left, gastric colic, and only with the progression of the disease 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 solar plexus or closer to the ribs.

It should be remembered that this is not necessarily appendicitis, symptoms during pregnancy, especially in last trimester, may arise from different reasons, for example, quite severe pain appears with increased gas formation. Such probabilities further complicate the definition of appendicitis in pregnant women.

Signs of appendicitis

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

• the pain is on the rise, the condition is rapidly deteriorating, 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 up to your stomach, it weakens;
• when trying to determine the development of appendicitis by pressing on the abdomen and abruptly releasing, you may not get a result; in pregnant women, the expected pain does not always occur, even in the case of developing inflammation;
• the appearance of weakness, even fainting;
• temperature increase is possible, 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;
• general analysis blood will reveal the presence increased amount erythrocytes.

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

Diagnosis of appendicitis

An accurate diagnosis can be made immediately only by examination by laparoscopy. Through a small puncture, a probe with a sensor is inserted into the presumed area of ​​localization of the blind process 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. With a marked deterioration, the diagnosis is confirmed. In addition, a urinalysis examination is performed. Considering that the symptoms of appendicitis in women during pregnancy and the 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 a disease of the bladder or kidneys.

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

If classical methods it is not possible to determine the presence of pathology with certainty, the woman remains under the supervision of doctors. In this case, you can 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 carry out the operation

Treatment of an inflamed blind process can only be surgical, and in no case should this be postponed, since this disease poses a serious danger 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 the recovery period includes vitamins, drugs that help normalize blood flow, good bowel function. Drugs are also recommended to support uterine muscle tone and prevent spasms. Bed rest is usually prescribed.

The mother-to-be who had to undergo surgical intervention, will be under the supervision of a doctor until the end of the child's gestation period, since there is a risk of premature delivery.

If surgery was performed in recent weeks gestation, then an enhanced monitoring of the condition of the future mother and fetus is carried out, as well as especially careful monitoring of birth process. This is due to the fact that during attempts, surgical sutures can disperse.

Danger of inflammation of the appendix

A similar pathology during pregnancy occurs frequently, about 5% of women per different terms face such a problem. Therefore, there is no need to be afraid, the main thing is to seek help if pain occurs.

In no case should you self-medicate, take painkillers, postpone a visit to the clinic. The occurrence of colic or pulling pains may mean beginning 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 drugs that a woman will have to take before and after surgery, but the risk of using these drugs is much lower than the consequences of peritonitis, which will begin if the inflamed appendix is ​​not removed in time. In this case, a woman can die.

Therefore, if the doctor is not sure that the cause of the pain lies elsewhere, he has to make a decision on the appointment of the operation under his own responsibility.

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

However, the uncomplicated form of appendicitis is more often manifested, 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.

At different times, the degree of risk is different, but there are sad statistics:

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

Possible complications that may occur at any time:

• the loss of a child;
• early delivery;
• various complications after surgery;
• acute intestinal obstruction;
• violations of the functions of the muscles of the uterus;
• lack of oxygen in the blood, which can lead to fetal hypoxia;
• bleeding may occur after childbirth.

The highest risk of negative consequences present in the first few days after surgical intervention.

Conclusion

If there is pain, weakness, nausea, everything should not be attributed to toxicosis. At an early stage, the signs of appendicitis can be similar to the usual minor ailments of a pregnant woman, so it's best to check with your doctor.

Suspicion of appendicitis and ordinary life occur quite frequently. And in women who are carrying a pregnancy, probably even more often. The good news is that in most cases, the alarm turns out to be, nevertheless, false. But you should never ignore abdominal pain. First, they can indicate a variety of problems. Secondly, pregnancy is considered one of the predisposing factors to the development of this pathology. Thirdly, if it turns out that the appendix is ​​inflamed, then you will have to act without delay: all the risks are now increasing, because two lives can be in danger at once.

But in reality, everything is not so scary: appendicitis during pregnancy is successfully treated if it is detected on time.

Where is appendicitis during pregnancy: how and where does it hurt

Appendicitis is called inflammation of the appendix - the appendix of the caecum, which in our body does not perform any functions, but with inflammation can create considerable problems. Anatomically, the blind process is located on the lower right, and therefore pain in appendicitis is usually localized in this area of ​​the abdomen. But with the diagnosis of the disease, everything is much more difficult ...

Surgeons call appendicitis very insidious disease: there is not a single sign that would allow us to confidently recognize appendicitis during pregnancy, and there is only one diagnostic method, which allows you to reliably determine this disease, but it is not available in every city clinic.

The most striking symptom of appendicitis - pain in the abdomen, in the right lower side - is at the same time quite difficult to recognize. All because on initial stage inflammation of the appendix pain can be localized, almost anywhere in the abdominal cavity. And only with the progression of the disease does it “stop” at the location of the appendix. And even in this case, there are difficulties: not all people have an appendix in a strictly defined place. And in pregnant women, it is constantly shifting under the pressure of the growing uterus and fetus.

So, all the same, where does appendicitis hurt in pregnant women?

The blind process is located in the right iliac region of the abdomen, that is, in its lower part, in the area between the lower ribs and pelvic bones. However, with individual anatomical features of the location, the appendix may be slightly higher (closer to the liver) or slightly lower (closer to the bladder) than usual in someone. In view of such features, pain in appendicitis in the first case may be accompanied by nausea and vomiting, pain in the stomach, and in the second - signs of inflammation of the genitourinary organs, and even give to the lower back or right leg.

Appendix pain can even begin on the left side of the abdomen or from the epigastric region (near the stomach), but as the disease progresses, it gradually passes precisely into the area where the inflamed process of the caecum is located and makes itself felt by constant whining.

If your appendix is ​​inflamed early dates pregnancy, then, most likely, the place of localization of such pain will be just the right iliac region (from below). From the second trimester onwards, later dates pregnancy, appendicitis is manifested by pain a little higher in the right side - at the level of the navel or even closer to the ribs. The longer the gestation period, the theoretically higher the appendix can be, which is forced out of its usual location by the growing uterus and fetus.

How to recognize appendicitis during pregnancy: symptoms and signs

Now you should have no doubts whether appendicitis in pregnant women can hurt. We have just found out that it is quite possible. And then the question is brewing, how can you determine that the problem really exists? After all, abdominal pain during pregnancy accompanies a large number of very different conditions and disorders, not all of which are dangerous. By the way, it is in pregnant women that such acute pain often occurs due to intestinal colic or increased gas production. Therefore, to distinguish inflammation of the appendix from other conditions and disorders is really not an easy task.

To finish with pain syndrome Let's take a look at some of its other distinguishing features:

• pain with appendicitis is constantly increasing - the patient's condition is rapidly deteriorating within a day or more, other symptoms may gradually join;
• when walking, as well as in the position lying on the right side, pain intensify, in a position on the back with legs pressed to the stomach - weaken;
• the Shchetkin-Blumberg symptom (when the pain intensifies at the moment of abrupt release after strong pressure on the abdomen) is not always informative for pregnant women: due to some features, a woman may not feel sharp pain and tension in this area even against the background of acute inflammation of the appendix.

In addition, against the background of acute appendicitis, body temperature may rise, chills appear, severe weakness, nausea, vomiting, and loss of consciousness occur. All these signs, as you can judge, are not specific. If the condition develops in the first trimester of pregnancy, then they can be taken as symptoms of toxicosis.

And therefore, it is impossible to make a diagnosis only on the basis of complaints of a pregnant woman: the doctor will certainly begin to examine a woman with such symptoms.

How to diagnose appendicitis during pregnancy

We have already mentioned that making an accurate diagnosis is very difficult and not always possible. This is possible only with the help of laparoscopy, when through a puncture in abdominal cavity a video sensor is introduced, which allows you to see and evaluate the condition of the appendix from the inside. If the inflammation is confirmed, then such a diagnostic manipulation immediately turns into medical procedure: the appendix of the caecum is removed. This is one of the most significant advantages of the laparoscopic method.

But, unfortunately, it is not always possible to resort to it, because not every clinic is equipped with modern equipment and specially trained personnel. If there is no laparoscope, then the doctor will act according to classical scheme. First, he will carefully listen and examine the pregnant woman. Then, if suspicions of appendicitis remain, the patient will be hospitalized and will be monitored - a clear progressive deterioration in well-being will testify in favor of the development of pathology.

Meanwhile, the expectant mother is being examined. Since the symptoms of appendicitis and acute inflammatory processes in the organs of the genitourinary tract are quite similar, it is necessary to take a urine test: elevated leukocytes in the urine during pregnancy indicate the development of kidney or bladder disease. If these indicators are normal, then suspicions of appendicitis increase. At the same time, it indicates pathology high level leukocytes in the blood.

Bring some clarity to clinical picture capable of ultrasonic examination. Inflammation of the blind process can be seen with ultrasound, but, unfortunately, not always. Therefore, if the study did not reveal anything, then this does not mean at all that there is nothing.

Then it remains to observe the pregnant woman and prepare for the operation.

It should be noted that taking any medications, including painkillers, if you experience severe pain in the stomach is impossible. You need to immediately contact a doctor - a gynecologist or surgeon, who will determine further tactics.

Is it possible to cut out appendicitis during pregnancy: surgery, anesthesia

Regardless of who has been diagnosed with appendicitis (whether it be a child, an elderly or a pregnant woman), its treatment is always carried out in one way - surgically, that is, the inflamed process is removed. And this must be done in a short time: inflammation progresses very quickly and poses great dangers to the patient's life.

If the operation is performed traditionally surgical method(that is, with the opening of the abdominal wall), then general anesthesia is used. Even at the stage of preparation for the operation, as well as in recovery period the expectant mother is prescribed approved antibiotics to prevent the inflammatory process and intrauterine infection. Postoperative therapy may also include vitamins and drugs to relieve spasms and relax the muscles of the uterus, calm, improve uteroplacental flow, and normalize bowel function. It will be necessary to stay in bed longer than usual after such operations.

Pregnant women who have undergone appendectomy are at risk for premature start childbirth, and therefore until the end of the gestation period should be under medical supervision. The closer to the expected date of birth the operation takes place, the more strengthened the control over the birth process, the condition of the mother and child should be. There is a high risk of divergence of the postoperative suture, and therefore the birth tactics in such cases may differ somewhat (in particular, the woman is likely to have her stomach bandaged tightly and an incision will be made immediately at birth of the head in order to shorten the period of attempts).

What is dangerous appendicitis during pregnancy: consequences

You should not be afraid of the operation: it is the removal of appendicitis that occupies the bulk of all surgical interventions during pregnancy. Of course, the drugs used in the treatment of appendicitis can have Negative influence on the fetus, and there is a risk of other complications due to the operation (intestinal obstruction, partial detachment placenta, etc.), but they are incommensurable with the danger posed by the rupture of the appendix that was not removed in time. Such an outcome is fraught with many likely serious problems, including necrotization (death) of tissues, intoxication of the body, peritonitis, pylephlebitis, abscess, sepsis, miscarriage. A woman risks losing not only the child, but also her own life.

That is why surgeons prefer to remove appendicitis during pregnancy, even if the probability of its inflammation is only 50%, and to be honest, always when the doctor cannot rule out the development of pathology with certainty. This is a kind of Russian roulette, but very high stakes are at stake. And, of course, not only women, but also doctors sometimes find it difficult to decide what to do if appendicitis is suspected in a pregnant woman.

Who had appendicitis during pregnancy: reviews

In practice, there are often cases when appendicitis is cut out for pregnant women "by mistake", that is, only suspecting a disease, the development of which is not confirmed when opening the abdominal cavity. On the forums, you can find numerous similar reviews in which women who have already given birth safely are indignant and scold doctors.

But there are other stories when procrastination misdiagnosis, the negligence of doctors or the irresponsibility of expectant mothers led to tragic consequences.

Only in a few individual cases it becomes reliably known that the inflammation of the appendix is ​​in the "height" and it needs to be urgently removed. More often, however, you have to take responsibility and make, perhaps, a difficult decision ...

Probably, it makes sense to listen to the opinion of an experienced surgeon. And numerous reviews of women who survived the removal of appendicitis during pregnancy confirm that children's health it has no effect.

May God grant that you do not face a difficult choice. But if the circumstances are different, then always act in consultation with your doctor.

Be healthy!

Especially for - Larisa Nezabudkina

Pregnancy is a wonderful time of waiting. The expectant mother should enjoy her position and not think about the bad. But, unfortunately, this stage can be overshadowed by health problems.

One of these possible problems It's appendicitis during pregnancy. Is he dangerous? And how is the treatment in this case?

Appendicitis is an inflammation of the so-called appendix, which in medical practice is called the appendix. Such an offshoot is considered a rudiment, that is, in fact, which has become unnecessary for a person in the process of evolution.

But such bodies may well make themselves felt. As practice shows, in a quarter of the entire population, the appendix becomes inflamed. Age does not affect this condition, but most often appendicitis develops in young people (up to about 30 years old).

As for pregnant women, their appendix may also become inflamed, which is largely due to their position.

Of the total number of women who have had appendicitis, about 5% are expectant mothers. Acute appendicitis, by the way, is more common in pregnant women than in ordinary people.

There are two forms of this condition: catarrhal and destructive. In the first case, the appendix increases in size, becomes edematous, but remains intact, that is, pus cannot pour into the abdominal cavity.

The destructive form of the state, in turn, can be divided into several types:

• Phlegmous appendicitis greatly increases in size and is filled with pus. It is like a bubble that, under certain circumstances, can burst. Appendicitis passes from the first form to the second in about 6-12 hours, although sometimes everything happens much faster (in an hour), which is extremely dangerous.
• If, with phlegmous appendicitis, measures were not taken on time, then the following form may develop - gangrenous. At the same time, the tissues of the walls of the appendix gradually begin to die and collapse, it may well burst, which will lead to pus entering the abdominal cavity. In this state, the appendix can be about 12 hours.
• The last and most difficult form is perforated. It develops about a day after the first manifestations of inflammation. In this case, pus pours into the abdominal cavity and fills it. Because of this, an infection can develop, which is a threat to the life of the expectant mother and fetus. If within the next day you do not apply for medical care, then everything can end very sadly.

Causes

Until now, doctors have not established the exact causes of the development of this condition. It is believed that the appendix may become inflamed due to blockage of the lumen that connects the caecum and the appendix itself.

Why is this happening? Probably, stool, remaining in the intestines, harden and stony, forming stagnation. In addition, toxins that the body did not remove on time can also clog this lumen. And sometimes the condition is also affected by the position of the appendix (it can be different).

As for pregnancy, it in itself is in this case negative influence factor. Firstly, the uterus grows very quickly and can displace neighboring organs.

The intestines are especially subjected to displacement and compression. In this case, the appendix can move, which will lead to its inflammation. Secondly, during the period of bearing a baby, many women experience problems with stools, that is, constipation.

The stagnant contents of the intestine through the lumen can penetrate into the appendix or simply clog this very lumen.

Thirdly, with constipation, the intestinal microflora is disturbed, which can also serve as a kind of trigger. The fact is that pathogenic microorganisms may well get into the appendix and provoke the launch of pathological processes.

Symptoms

Manifestations of appendicitis, as a rule, do not go unnoticed, but expectant mothers often confuse them with increased tone uterus (and such a phenomenon is not uncommon) or other problems and processes directly related to pregnancy.

It is extremely important to notice the signs in time to see a doctor and avoid serious consequences. Let's list the symptoms:

1. First of all, there will be pain. At first, it will be felt exactly at the site of inflammation. As the uterus pushes the appendix up, discomfort will be located in the upper abdomen.
2. Then the pain will spread through the body, sink down. Often it is encircling, gives to the other side, lower back and back. If at first the sensations are not so strong, then the pain will be almost constant. At first they are aching or pulling, then they can also be cramping in nature. If you lie on your right side, the sensations will intensify.
3. Since the process presses on the uterus, hypertonicity may occur. The abdomen will become hard and may hurt a little.
4. Vomiting and nausea may occur (if the appendix puts pressure on the liver). If the process is located in the small pelvis, then squeezing the bladder will lead to painful urination.
5. Weakness is noted.
6. Often given state accompanied by an increase in temperature (sometimes quite significant).

Consequences

As already noted, the consequences can be very sad:

• Placental abruption may begin, which, in the absence of timely measures, can lead to fetal death.
• Probably bleeding.
• Another threat is hypoxia ( oxygen starvation) of the unborn child, which is the cause of irreversible changes in the brain and other organs of the fetus.
• The postoperative period with improper supervision of doctors can also be dangerous. So, there is a risk of developing intestinal obstruction (after surgery, bowel movement becomes more difficult). In addition, there is a possibility of infection.

Diagnostics

To detect appendicitis, it is necessary to carry out comprehensive examination. First, blood and urine tests are ordered. Secondly, an ultrasound examination is required.

But the most accurate results allows you to get laparoscopic diagnostics, which is carried out using a puncture of the abdominal cavity and placing a camera (endoscope) in it.

Treatment

The only one effective method fixing this problem is a surgical intervention. There is no other way, as to remove inflammation medications impossible. If it has begun, then in any case, the process must be removed. But the operation can be carried out in two ways:

1. Traditional operation. An incision 8-10 centimeters long is made in the abdominal cavity above the location of the appendix, through which an appendectomy is performed (removal of the process). If there is an abscess, then drainage tubes are installed through which the pus is brought out. Then stitches are applied, they are usually removed after a week.
2. The second method is laparoscopic surgery. Several punctures are made in the cavity. Through one, an endoscope is inserted (it allows you to see the cavity from the inside and find the focus of inflammation), and through the others, manipulators are placed (with their help, manipulations are performed). It is this method that is preferable for the expectant mother, since the risk of complications is reduced significantly.

Postoperative period

The likelihood of consequences increases in the first days after surgery. Future mother they will not put weight and ice on the stomach, as is usually done. A pregnant woman is shown strict bed rest, as well as sparing nutrition.

Doctors must certainly monitor the work of the intestines. In most cases, special soft drugs are prescribed to prevent constipation.

In addition, if the uterus begins to contract, then drugs can be prescribed that relax muscles and relieve spasm (for example, Papaverine and others like that).

Another important measure is to prevent the development of infection (after surgery, this probability is quite high). To do this, the doctor will prescribe antibiotics, which must be selected with great care and taking into account the position of the woman.

After 2-3 weeks, the pregnant woman can return to habitual way life.

We can only add that appendicitis while carrying a baby is dangerous, but if measures are taken in time, the consequences can be avoided.

Many women during gestation believe that discomfort or soreness in the abdomen is associated only with their position, but this is not always the case. Few people know, but it is pregnancy that can provoke inflammation of the appendix. It should be clearly understood what kind of symptoms occur with appendicitis during pregnancy and how you can deal with the disease.

General information about appendicitis in pregnancy

Appendicitis is an inflammatory process localized in the area of ​​the appendix (appendix), resulting in abdominal pain, accompanied by pathological changes in the intestine. It should be noted that a woman is diagnosed with the syndrome during pregnancy somewhat more often than in the absence of such a situation.

According to statistics, more than 3.5% of all pregnant women undergo treatment for appendicitis.

There is no doubt that any pathological change in the body of a future mother is a threat not only to her own health, but also to the development of the fetus. Diagnosing a disease in early pregnancy is an opportunity to prevent negative consequences for both mother and baby in a timely manner. If appendicitis is detected during the second trimester, the risks increase greatly.

Among the main threats to a happy future are:

• risk of abortion;
• intestinal obstruction;
• infection of both mother and fetus.

But in the case of an adequate timely treatment all risks and negative outcome are extremely rare. The infection in the body of the expectant mother, as a rule, occurs after surgery. For this reason, all pregnant women after the removal of the appendix are prescribed prophylactic antibiotic treatment in order to prevent negative consequences.

Causes of the development of the disease during pregnancy

To date, doctors do not have a clear answer to the question regarding the causes of appendicitis during the period of gestation by a woman. However, the most common theory-hypothesis is that the fetus may contribute to blockage of the lumen that is present between the cavity of the caecum and the appendix. As a rule, this condition contributes to disruption of the circulatory processes in the intestines, and as a result, edema and inflammation of the appendix.

Doctor's opinion: during the period of fetal maturation, the uterus of a pregnant woman increases and, depending on the anatomical features and additional conditions it can put pressure on the intestinal wall.

There are other views on the etymology of the process, however, inflammation due to impaired blood circulation in the walls of the caecum is the most reasonable and most common theory for the development of appendicitis during pregnancy.

Other factors in the development of inflammation of the appendix include:

• displacement of the caecum and appendix up and closer to the surface of the body due to an increase in the uterus, leading to bending of the appendix;
• during pregnancy, the tendency to constipation increases, due to which dense fecal masses are formed that can lead to blockage of the intestine;
• restructuring of the woman's immunity, in particular, the lymphoid system in the region of the caecum;
• during the bearing of a child, the composition of the blood changes, which increases the likelihood of the formation of blood clots and spasms.

Symptoms

In clinical medicine, there are two main forms of the course of the disease:

• catarrhal;
• destructive.

In the catarrhal form, the period of development of the disease does not exceed 12 hours, then a rupture of the appendix wall may form, and all the contents of the inflamed process enter the abdominal cavity. In the second case, the period of development of the syndrome takes up to several days.

It is impossible to clearly distinguish the symptoms that distinguish pregnant women with such a problem, since this disease can manifest itself in different ways in each case. It should also be noted that the process in all cases will have a different localization, therefore, painful sensations can occur in the most different areas belly.

If the inflammatory process affects only the appendix, then the localization of painful sensations is defined as severe discomfort in the upper central part of the abdomen. Then the sensations migrate to the right lower abdomen. Often, along with pain, a woman feels nausea, vomiting, and indigestion may occur.

In some cases pain symptom localized immediately in all areas of the abdomen, in this situation, the sensations may be insignificant. On palpation, pain may not occur immediately and change in nature and localization.

Doctor's note: pregnant women who have an inflammatory process in the intestines may experience discomfort when they lie on their right side. Under such conditions, the uterus will exert the greatest pressure on the caecum.

As the disease progresses, pain becomes more clearly localized, affecting the right iliac region. In some cases, severe discomfort can rise up and even give to the right hypochondrium, making breathing difficult. The degree of soreness is proportional to the gestational age - the larger the uterus, the higher the pressure on the inflamed segment of the intestine.

It is worth taking into account the fact that pregnancy can distort both the picture of the course of the disease and the symptomatic complex. Individual sensations may intensify, or, conversely, not actually be felt - it depends on the duration of pregnancy and on individual characteristics every woman. So, the process of "ripening" of the inflamed process due to the pressure of the uterus on it either slows down or becomes prone to overactive development, leading to irreversible consequences as soon as possible.

The localization of the process can add confusion during the diagnosis, causing symptoms similar to cystitis (with a low location of the appendix) or gastritis (with localization in the hypochondrium).

As part of the course of the disease in acute or chronic form, several specific symptoms can be distinguished.

Signs of acute and chronic forms of the disease

Features of the manifestation of the disease and diagnosis

The main complaints during examination of pregnant women are aimed at elevated temperature body, asthenic complex (weakness, depression), as well as painful sensations. The pain is most often localized in the lower right abdomen and increases in the process of walking. During palpation, negative sensations occur when the doctor reduces pressure on the abdomen.

To confirm the disease and discard other hypotheses, a number of examinations are carried out:

• Blood analysis. The conclusion is made on the basis of the number of leukocytes. It should be noted that an increased value may not be evidence of appendicitis, since leukocytosis is also noted in cases of infection or inflammation in the human body. For this reason, a complete blood count is not the only method of collecting data for a specific problem.
• Ultrasonography. One of the main ways to identify an ailment in a woman who is in position. This diagnostic process allows not only to see the presence of inflammation in the appendix area, but also the nature of the abscess. However, ultrasound is not always effective method diagnosis, since it is possible to make a diagnosis on its basis only in half of the cases.
• Laparoscopy. This type of diagnosis is the most effective in terms of diagnosis. During the process, the doctor makes a small incision, allowing you to insert a laparoscope into the abdominal cavity, at the end of which there is a camera. This method allows you to study in detail all the organs in the peritoneum, including identifying inflammation in the appendix. If surgical intervention is necessary, the process is immediately carried out, preventing the development of inflammation and the progression of the disease.

Of course, the process of making a diagnosis during pregnancy is complicated by the current situation of the girl, since the fetus in most cases distorts sensations. future mother. To avoid negative consequences, at the first suspicion of appendicitis, you should go to the hospital, where high-quality diagnostics will be carried out.

Treatment

The only treatment for appendicitis in pregnant women is to remove the inflamed process through surgery. The following methods apply:

• classical resection;
• laparoscopy.

The standard type of operation is implemented through a small incision in the peritoneum slightly higher than the appendix is ​​located. The size of the incision on average does not exceed ten centimeters. First of all, the doctor examines the process and the space adjacent to it in order to exclude the presence of additional processes that can complicate the operation and lead to subsequent disorders.

If the nature of the pathology is clear, then the process is excised. If there is a perforation of the intestinal wall and the development of an abscess, the abdominal cavity is dried with drainage, which is brought out. Then the surgeon puts stitches, which are removed after a week, but only if the recovery process is favorable.

If the laparoscopic method is used to treat appendicitis, then a special optical system is inserted into the abdominal cavity, which allows the appendix to be removed through small holes. Undoubtedly, this method has many advantages over classical resection:

• postoperative pain is significantly reduced;
• the recovery process is much faster, etc.

Laparoscopy also guarantees a good cosmetic effect, as there is no trace left on the skin after the operation. This is the most effective and common method of intervention for the treatment this disease especially when it comes to a young, pregnant girl.

After the removal of the appendix, pregnancy and childbirth are often complicated, the following problems may occur:

• increased risk of preterm birth and placental abruption;
• anomalies of the contractile work of the uterus during labor;
• fetal hypoxia;
• the postpartum period is often complicated by bleeding;
• if a problem occurs in the second trimester, the risk of miscarriage increases by 3 times;
• if the inflammation is complicated by perforation, then the risk of death of the child is approximately 25%.

Recovery period after surgery

The process of recovery of a pregnant woman is somewhat different from the classical rehabilitation of an ordinary patient after removal of appendicitis. It should be noted that after the operation, pregnant women do not apply cooling compresses to the abdominal area, which contribute to the speedy healing and prevention of edema. This approach is inappropriate, since the cold negatively affects the unborn child and can lead to violations normal course pregnancy.

Specialists are developing a special sparing regimen that contributes to the speedy recovery. At the same time, a special power supply system is extremely important and additional funds, which will normalize the work digestive system. So, after surgery, every woman is faced with a complex of antibiotic drugs that undergo strict “censorship” so as not to negative impact to the fruit.

Maintenance therapy is also carried out, aimed at maintaining pregnancy and maintaining normal state future baby. In most cases, assigned vitamin complexes and tonics, strict bed rest.

After the future woman in labor has been discharged from the hospital, she is automatically included in the list of persons at risk of premature birth or termination of pregnancy.

Postoperative Diet

The diet of a pregnant woman after removal of the appendix is ​​developed by a specialist, taking into account her current condition. It is important to note that the first three days are the most difficult, since the process of eating is not only clearly controlled, but also significantly limited. In a situation with pregnant women, the diet is accompanied by routine droppers with a nutrient solution, which is a key element of restorative therapy.

Basic rules for the nutrition of a pregnant woman after an operation to remove appendicitis:

• the first 12 hours after the procedure, there is usually no appetite, it is allowed to moisten the lips with water or take a few small sips;
• after the expiration of the day normal course the postoperative period is allowed to eat a little low-fat broth on chicken or jelly cooked on fruit;
• it is important that the first week after the operation, meals are frequent, portions are small, and the food itself is liquid or puree-like;
• can be consumed following products: natural yogurt, boiled chicken meat and broth, mashed potatoes, pumpkin or zucchini;
• the first week should avoid food that provokes increased gas formation or inflammatory processes (sour, smoked, spicy, legumes);
• to normalize the stool, baked vegetables, cereal soups, dried fruits are gradually introduced into the diet, dairy products, lean meat and fish;
• It is important to drink plenty of fluids - at least 8 glasses a day.

Appendicitis is one of the most common diseases for which surgery is the only solution. Pregnancy in some way complicates the process of diagnosis, treatment and recovery of the patient, but the prognosis is positive. But the risk always remains. In such a situation, not only the attention of specialists for a pregnant woman is enhanced, but the birth itself is carried out in especially controlled conditions.