Treatment of choice of the pregnant lady with appendicitis is:
Ans: A (Surgery at earliest) Acute Appendicitis During Pregnancy Dutta obstetrics 6th/ 304Incidence is about 1 in 2000 pregnancies.Diagnosis is difficult in pregnancy because of:1. Nausea and vomiting common in normal pregnancy are also the common symptoms of appendicitis2. Leucocytosis is common in normal pregnancy, (c) Appendix moves upwards and outwards as the uterus enlarges. So pain and tenderness may not be located in the right iliac fossa, (d) Diagnosis is often confused with disturbed ectopic pregnancy, pyelonephritis, twisted ovarian cyst, abruption placenta and red degeneration of afibroid.Effect of appendicitis on pregnancy- may lead to abortion, premature delivery, increased perinatal mortality and maternal mortality.Effect of pregnancy on appendicitis is not so good. This is because of (a) late diagnosis, (b) failure of localization due to displacement of the position and as such (c) peritonitis is more common, specially, in last trimester.Treatment consists of laparotomy at the earliest opportunity. Once the diagnosis is suspected it is better to operate rather than to wait until generalised peritonitis has developed. The incision should be made at the point of maximum tenderness. For the approach to the site, evacuation of the uterus may be required
Surgery at earliest
Abortion with appendectomy
Surgery after delivery
Continue pregnancy with medical Rx
Miscellaneous (Gynae)