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Kenneth Moise, M.D., Baylor College of Medicine, Houston, Texas

LOS ANGELES, Oct. 29 — Misdiagnosis of appendicitis during pregnancy places almost a quarter of affected women at risk of fetal loss, investigators here have concluded.

When a normal appendix is removed, the risk of fetal loss is almost double the risk faced with a case of simple appendicitis, Marcia L. McGory, M.D., of UCLA, and colleagues reported in the November issue of the Journal of the American College of Surgeons. Action Points
Explain to interested patients that inaccurate diagnosis of appendicitis is more likely in pregnant women than in nonpregnant women.

Note that an unnecessary appendectomy during pregnancy increases the risk of fetal loss.

“These data indicate that reducing fetal loss in pregnant women suspected of having acute appendicitis will require more accurate diagnosis to avoid unnecessary operation,” the authors concluded.

Appendectomy for presumed acute appendicitis occurs in one of every 766 births, making it the most common surgical emergency during pregnancy, the researchers said. Yet studies have shown that in 25% to 50% of cases, the preoperative diagnosis is incorrect.

The authors cited two principal reasons for the high rate of misdiagnosis. First, appendicitis is difficult to diagnose in women. In one review the overall diagnostic accuracy for appendicitis in women was 75.3%, but varied between 50% and 96.7% (CMAJ 1995; 152: 1617-1626). Second, pregnancy alters the clinical presentation of appendicitis, particularly in women who are close to term.

To add more contemporary data to the discussion, Dr. McGory and colleagues reviewed records on 94,789 women who underwent appendectomy in California between 1995 and 2002. The total procedure count comprised 3,133 appendectomies during pregnancy.

The data analysis showed that 30% of pregnant women and 29% of nonpregnant women had complicated appendicitis, which was defined as acute appendicitis with generalized peritonitis or peritoneal abscess. Pregnant women had a significantly higher rate of negative appendicitis (23% versus 18%, P
Primary source: Journal of the American College of Surgeons
Source reference:
McGory ML, et al “Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss” J Am Coll Surg 2007; 205: 534-540.

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This entry was posted on Sunday, April 29th, 2007 at 9:10 pm and is filed under General health, News, Pregnancy, Womens Gynecological. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.