Acute appendicitis
during pregnancy is one of the common acute abdomen during pregnancy, and its morbidity mechanism is special, so the treatment should be cautious. The morbidity mechanism and treatment of acute appendicitis during pregnancy will be discussed in detail in order to provide valuable reference for clinicians.
1. Mechanism of morbidity 1. Changes in anatomical position: With the enlargement of the pregnant uterus, the anatomical position of the cecum and appendix was gradually pushed upward, outward and backward. This change in location makes the location of abdominal pain and tenderness of appendicitis change accordingly, which brings some difficulties to diagnosis. 2. Physiological changes: The increased levels of estrogen and progesterone during pregnancy increase capillary permeability and tissue proteolysis, which inhibit the immune mechanism and easily lead to appendiceal gangrene and perforation. At the same time, the enlargement of the uterus leads to the upward movement of the greater omentum, which is not easy to wrap and localize inflammation, and is prone to secondary diffuse peritonitis. 3. High risk in the middle and late stages of pregnancy: In the middle and late stages of pregnancy, due to the rapid enlargement of the uterus, the position of the appendix changes more significantly, and at this time the placenta has been formed, the sensitivity of the uterus is reduced, although the operation is not affected, but the rate of appendiceal perforation and mortality rate is higher than that in the early stage of pregnancy.
II. Clinical signs
. The clinical signs of acute appendicitis
in pregnancy may vary according to the stage of pregnancy and the location of the appendix. Common symptoms include metastatic right lower abdominal pain, nausea, vomiting, fever and so on. However, due to the enlargement of the uterus and the change in the position of the appendix during pregnancy, these symptoms may become atypical and may even result in more pain in the right lower back than in the abdomen. In addition, pregnant women may also have uterine contractions, fetal restlessness and other manifestations.
3. Diagnosis
In the
diagnosis of acute appendicitis during pregnancy, it is necessary to fully consider the special circumstances of pregnant women, combined with medical history, clinical signs, physical examination and auxiliary examination. Blood routine examination showed an increase in white blood cell count and an increase in the proportion of neutrophil. B-ultrasound examination can show the appendix as a hypoechoic tubular structure, which has a high accuracy in the diagnosis of acute appendicitis. If the condition is serious, CT examination can also be considered to confirm the diagnosis. However, it should be noted that pregnant women should try to protect the fetus from radiation damage during CT examination.
4. Treatment 1. Surgical treatment: Once acute appendicitis during pregnancy is diagnosed, surgical treatment should be carried out as soon as possible in principle. The purpose of the operation is to remove the diseased appendix and prevent the spread of inflammation and complications. Surgical methods can be selected according to the specific conditions of pregnant women, including open surgery and laparoscopic surgery. Laparoscopic surgery has the advantages of small trauma and quick recovery, but it is relatively difficult to operate and requires rich surgical experience. 2. Conservative treatment: For pregnant women with mild symptoms and in stable condition, conservative treatment can be considered. Conservative treatment includes intravenous infusion, antibiotics and pain relief. However, conservative treatment should be chosen carefully, because if the disease progresses rapidly, it may lead to serious complications such as appendiceal perforation and diffuse peritonitis. 3. Postoperative management: It is necessary to closely monitor the vital signs of pregnant women and the condition of the fetus, control abdominal infection in time, and reduce the stimulation to the uterus. At the same time, tocolytic treatment is also needed, such as routine intramuscular progesterone injection in early pregnancy and uterine contraction inhibition in the second trimester of pregnancy.
5. The key to prevent acute appendicitis during pregnancy is to strengthen the health education of pregnant women and improve their awareness and vigilance of appendicitis. Pregnant women should pay attention to maintaining good living habits and eating habits during pregnancy, and avoid overwork and overeating. At the same time, regular prenatal examinations should be carried out to detect and deal with potential disease risks in a timely manner.
To sum up, the morbidity mechanism of acute appendicitis during pregnancy is special, and the clinical signs is not typical, so the diagnosis and treatment should be cautious. Clinicians should fully understand the morbidity mechanism and treatment principles, and formulate individualized treatment plans according to the special conditions of pregnant women to ensure the safety of mothers and infants.
Pregnancy complicated with appendicitis
