Obstetrics & Gynecology>>>>>Medical and Surgical Complications of Pregnancy
Question 5#

A 17-year-old woman at 22 weeks’ gestation presents to the emergency department with a 3-day history of nausea, vomiting, and abdominal pain. The pain started in the middle of the abdomen, and is now located along her mid-to-upper right side. She is noted to have a temperature of 38.4°C (101.1°F). She reports no prior medical problems or surgeries.

How does pregnancy alter the diagnosis and treatment of the disease? 

a. Owing to anatomical and physiological changes in pregnancy, diagnosis is easier to make
b. Surgical treatment should be delayed since the patient is pregnant
c. Fetal outcome is improved with delayed diagnosis
d. The incidence is unchanged in pregnancy
e. The incidence is higher in pregnancy

Correct Answer is D

Comment:

The incidence of appendicitis in pregnancy is 1 in 2000, the same as that in the nonpregnant population. The diagnosis can be difficult to make during pregnancy because leukocytosis, nausea, and vomiting are common in pregnancy. In addition, the upward displacement of the appendix by the uterus may cause appendicitis to have a nonclassic presentation. Surgery is necessary even if the diagnosis is not certain. Rupture of the appendix is more likely in pregnant women, likely due to the delay in diagnosis and reluctance to operate on pregnant women.