# Acute appendicitis during pregnancy: a retrospective case series of seven cases

## TL;DR

This study examines seven cases of acute appendicitis during pregnancy, highlighting diagnostic challenges and outcomes.

## Contribution

The study identifies predictors of complicated appendicitis during pregnancy, emphasizing the role of delayed consultation and elevated CRP.

## Key findings

- Delayed consultation and elevated CRP are predictors of complicated appendicitis in pregnancy.
- Ultrasound confirmed appendicitis in 86% of cases, with atypical localization in the third trimester.
- All patients underwent open surgery with no maternal deaths, but one fetal death occurred.

## Abstract

Acute appendicitis is the most frequent non-obstetrical surgical emergency during pregnancy. Anatomical displacement of the appendix and atypical symptoms complicate diagnosis, often delaying treatment and increasing maternal–fetal risks. A retrospective study of seven pregnant women treated for acute appendicitis at National Maternal and Child Health Center between 01 January 2023 and 31 December 2024. Epidemiological, clinical, diagnostic, therapeutic, and outcome data were analyzed using descriptive and inferential statistics. Mean age was 31 years (SD 7.2; range 21–42). Most cases occurred in the third trimester (57%). Four cases were recorded in 2023 and three in 2024. Farmers represented 57% of patients, workers 29%, and housewives 14%. Geographically, cases originated from six provinces, with Tboung Khmum contributing the highest number (29%). Consultation delay was longer in complicated appendicitis (mean 5.2 vs. 2.3 days, P < .05). Elevated C-Reactive Protein (CRP) (>50 mg/L) was significantly associated with advanced forms (χ2 = 4.9, P = .027). Ultrasound confirmed appendicitis in 86% of cases, with atypical localization more frequent in the third trimester (P < .05). All patients underwent open surgery: McBurney (1 case), para-median (1 case), or modified McBurney (5 cases). Antibiotic regimens were tailored to severity. No maternal deaths occurred; one fetal death with premature delivery at 31 weeks was noted. Inferential analysis confirms that delayed consultation and elevated CRP are predictors of complicated appendicitis in pregnancy. Systematic ultrasonography and rapid intervention are essential to reduce morbidity.