Set low threshold for appendectomy in pregnant women.(Obstetrics)

PASADENA, CALIF. -- The diagnosis of appendicitis can, of course, be exquisitely difficult in a nonpregnant patient. Pregnancy only makes the task more daunting.

However, the challenge must be met because early diagnosis and prompt surgery may mean the difference between life and death for both the mother and the fetus, said Dr. J. Gerald Quirk, who is professor and chairman of obstetrics, gynecology, and reproductive medicine at the State University of New York at Stony Brook.

"The risks of temporizing appendicitis in pregnant women are quite grave," he warned at a meeting of the Obstetrical and Gynecological Assembly of Southern California.

Approximately 1 in 1,000 pregnancies are complicated by appendicitis, noted Dr. Quirk. Appendectomy confirms the disease in two-thirds to three-fourths of patients.

Unfortunately, perforation is not an uncommon result of delay, with dire consequences. While fetal mortality occurs as a result of unperforated appendicitis in 3%-5% of cases, a perforated appendix is associated with the much higher fetal mortality rate of 20%-30%.

Maternal mortality, seen in approximately 0.1% of cases of unperforated appendicitis, rises precipitously to 4% with perforation.

The threshold for surgery should therefore be low, and increasingly so as the pregnancy progresses, since perforation is twice as common in the third trimester as it is in the first or second. "What you're doing is just increasing the risks ... by waiting."