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APPENDICITIS IN PREGNANCY

Published online by Cambridge University Press:  01 November 2012

CATHERINE M WINDRIM  and
MARIE J CZIKK
CATHERINE M WINDRIM
Affiliation:
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto ON, CanadaM5G 1X5
MARIE J CZIKK*
Affiliation:
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto ON, CanadaM5G 1X5
*
Dr Marie J Czikk, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, 600 University Avenue, Room 3265, Toronto ONCanadaM5G 1X5 Email: mczikk@mtsinai.on.ca
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Extract

Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnancy, complicating 1/500 to 1/2000 deliveries. Due to the anatomical and physiological changes associated with pregnancy, appendicitis may present a diagnostic dilemma, leading to management delays and thus increasing the risk of appendiceal perforation. Many of the common presenting symptoms of appendicitis are common features of normal pregnancy including lower abdominal pain, nausea, vomiting and leukocytosis. Furthermore, the enlarging gravid uterus may displace the appendix to varying degrees thus altering the classic symptom pattern of appendicitis. The often nonspecific presentation in pregnancy may necessitate the utilization of diagnostic imaging to aid in accurate diagnosis. However, the perforated appendix is the most common surgical cause of fetal loss and the time required for any diagnostic aid must be weighed against the increasing risk of perforation caused by delay in surgical intervention.

Type
Review Article
Information
Fetal and Maternal Medicine Review , Volume 23 , Issue 3-4 , November 2012 , pp. 276 - 295
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1Augustin, G, Majerovic, M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 2007; 131: 4–12.CrossRefGoogle ScholarPubMed
2Wang, PI, Chong, ST, Kielar, AZ, Kelly, AM, Knoepp, UD, Mazza, MBet al.Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations. Am J Roentgenol 2012; 198: 785–92.CrossRefGoogle Scholar
3Tamir, IL, Bongard, FS, Klein, SR. Acute appendicitis in the pregnant patient. Am J Surg 1990; 160: 571–75; discussion 575–76.CrossRefGoogle ScholarPubMed
4Mourad, J, Elliott, JP, Erickson, L, Lisboa, L. Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol 2000; 182: 1027–1029.CrossRefGoogle ScholarPubMed
5Mazze, RI, Kallen, B. Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 1991; 77: 835–40.Google ScholarPubMed
6Andersen, B, Nielsen, TF. Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 1999; 78: 758–62.CrossRefGoogle ScholarPubMed
7Mahmoodian, S. Appendicitis complicating pregnancy. South Med J 1992; 85: 19–24.CrossRefGoogle ScholarPubMed
8McGory, ML, Zingmond, DS, Tillou, A, Hiatt, JR, Ko, CY, Cryer, HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007; 205: 534–40.CrossRefGoogle ScholarPubMed
9Brown, JJ, Wilson, C, Coleman, S, Joypaul, BV. Appendicitis in pregnancy: an ongoing diagnostic dilemma. Colorectal Dis 2009; 11: 116–122.CrossRefGoogle ScholarPubMed
10Freeland, M, King, E, Safcsak, K, Durham, R. Diagnosis of appendicitis in pregnancy. Am J Surg 2009; 198: 753–58.CrossRefGoogle ScholarPubMed
11Babaknia, A, Parsa, H, Woodruff, JD. Appendicitis during pregnancy. Obstet Gynecol 1977; 50: 40–44.Google ScholarPubMed
12Weingold, AB. Appendicitis in pregnancy. Clin Obstet Gynecol 1983; 26: 801–809.CrossRefGoogle ScholarPubMed
13Yilmaz, HG, Akgun, Y, Bac, B, Celik, Y. Acute appendicitis in pregnancy–risk factors associated with principal outcomes: a case control study. Int J Surg 2007; 5: 192–97.CrossRefGoogle ScholarPubMed
14Baer, J, Reis, R, Arens, R. Appendicitis in pregnancy: with changes in position and axis of the normal appendix in pregnancy. JAMA 1932; 98: 1359–364.CrossRefGoogle Scholar
15Parangi, S, Levine, D, Henry, A, Isakovich, N, Pories, S. Surgical gastrointestinal disorders during pregnancy. Am J Surg 2007; 193: 223–32.CrossRefGoogle ScholarPubMed
16Zhang, Y, Zhao, YY, Qiao, J, Ye, RH. Diagnosis of appendicitis during pregnancy and perinatal outcome in the late pregnancy. Chin Med J (Engl) 2009; 122: 521–24.Google ScholarPubMed
17Babler, E. Perforative appendicitis complicating pregnancy: with report of a successful case. JAMA 1908; 51: 1310–313.CrossRefGoogle Scholar
18Cunningham, FG, McCubbin, JH. Appendicitis complicating pregnancy. Obstet Gynecol 1975; 45: 415–20.Google ScholarPubMed
19Andersson, RE, Lambe, M. Incidence of appendicitis during pregnancy. Int J Epidemiol 2001; 30: 1281–1285.CrossRefGoogle ScholarPubMed
20Wegmann, TG, Lin, H, Guilbert, L, Mosmann, TR. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today 1993; 14: 353–56.CrossRefGoogle ScholarPubMed
21Lopez, HBB, Berendtsen, H, Micheelsen, U. Acute appendicitis during pregnancy. J Obstet Gynaecol 1994; 14: 133–37.CrossRefGoogle Scholar
22Maslovitz, S, Gutman, G, Lessing, JB, Kupferminc, MJ, Gamzu, R. The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest 2003; 56: 188–91.CrossRefGoogle ScholarPubMed
23Coleman, MT, Trianfo, VA, Rund, DA. Nonobstetric emergencies in pregnancy: trauma and surgical conditions. Am J Obstet Gynecol 1997; 177: 497–502.CrossRefGoogle ScholarPubMed
24Tehrani, HY, Petros, JG, Kumar, RR, Chu, Q. Markers of severe appendicitis. Am Surg 1999; 65: 453–55.CrossRefGoogle ScholarPubMed
25Thompson, MM, Underwood, MJ, Dookeran, KA, Lloyd, DM, Bell, PR. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Br J Surg 1992; 79: 822–24.CrossRefGoogle ScholarPubMed
26Lemieux, P, Rheaume, P, Levesque, I, Bujold, E, Brochu, G. Laparoscopic appendectomy in pregnant patients: a review of 45 cases. Surg Endosc 2009; 23: 1701–705.CrossRefGoogle ScholarPubMed
27Sadot, E, Telem, DA, Arora, M, Butala, P, Nguyen, SQ, Divino, CM. Laparoscopy: a safe approach to appendicitis during pregnancy. Surg Endosc 2010; 24: 383–89.CrossRefGoogle ScholarPubMed
28Wallace, CA, Petrov, MS, Soybel, DI, Ferzoco, SJ, Ashley, SW, Tavakkolizadeh, A. Influence of imaging on the negative appendectomy rate in pregnancy. J Gastrointest Surg 2008; 12: 46–50.CrossRefGoogle ScholarPubMed
29Pedrosa, I, Lafornara, M, Pandharipande, PV, Goldsmith, JD, Rofsky, NM. Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology 2009; 250: 749–57.CrossRefGoogle ScholarPubMed
30Cobben, LP, Groot, I, Haans, L, Blickman, JG, Puylaert, J. MRI for clinically suspected appendicitis during pregnancy. Am J Roentgenol 2004; 183: 671–75.CrossRefGoogle ScholarPubMed
31Israel, GM, Malguria, N, McCarthy, S, Copel, J, Weinreb, J. MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging 2008; 28: 428–33.CrossRefGoogle ScholarPubMed
32Shetty, MK, Garrett, NM, Carpenter, WS, Shah, YP, Roberts, C. Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital. Semin Ultrasound CT MR 2010; 31: 8–13.CrossRefGoogle Scholar
33Barloon, TJ, Brown, BP, Abu-Yousef, MM, Warnock, N, Berbaum, KS. Sonography of acute appendicitis in pregnancy. Abdom Imaging 1995; 20: 149–51.CrossRefGoogle ScholarPubMed
34Lim, HK, Bae, SH, Seo, GS. Diagnosis of acute appendicitis in pregnant women: value of sonography. Am J Roentgenol 1992; 159: 539–42.CrossRefGoogle ScholarPubMed
35Wagner, LK, Huda, W. When a pregnant woman with suspected appendicitis is referred for a CT scan, what should a radiologist do to minimize potential radiation risks? Pediatr Radiol 2004; 34: 589–90.CrossRefGoogle Scholar
36Ames Castro, M, Shipp, TD, Castro, EE, Ouzounian, J, Rao, P. The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis. Am J Obstet Gynecol 2001; 184: 954–57.CrossRefGoogle ScholarPubMed
37Poortman, P, Oostvogel, HJ, Bosma, E, Lohle, PN, Cuesta, MA, de Lange-de Klerk, ESet al.Improving diagnosis of acute appendicitis: results of a diagnostic pathway with standard use of ultrasonography followed by selective use of CT. J Am Coll Surg 2009; 208: 434–41.CrossRefGoogle ScholarPubMed
38Long, SS, Long, C, Lai, H, Macura, KJ. Imaging strategies for right lower quadrant pain in pregnancy. Am J Roentgenol 2011; 196: 4–12.CrossRefGoogle ScholarPubMed
39Orr, RK, Porter, D, Hartman, D. Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med 1995; 2: 644–50.CrossRefGoogle ScholarPubMed
40Katz, DS, Klein, MA, Ganson, G, Hines, JJ. Imaging of abdominal pain in pregnancy. Radiol Clin North Am 2012; 50: 149–71.CrossRefGoogle ScholarPubMed
41Pedrosa, I, Levine, D, Eyvazzadeh, AD, Siewert, B, Ngo, L, Rofsky, NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology 2006; 238: 891–99.CrossRefGoogle ScholarPubMed
42Oto, A, Ernst, RD, Shah, R, Koroglu, M, Chaljub, G, Gei, AFet al.Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging–initial experience. Radiology 2005; 234: 445–51.CrossRefGoogle ScholarPubMed
43Rosen, MP, Ding, A, Blake, MA, Baker, ME, Cash, BD, Fidler, JLet al.ACR Appropriateness Criteria(R) right lower quadrant pain–suspected appendicitis. J Am Coll Radiol 2011; 8: 749–55.CrossRefGoogle Scholar
44Pedrosa, I, Zeikus, EA, Levine, D, Rofsky, NM. MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics 2007; 27: 721–43.CrossRefGoogle ScholarPubMed
45Lehnert, BE, Gross, JA, Linnau, KF, Moshiri, M. Utility of ultrasound for evaluating the appendix during the second and third trimester of pregnancy. Emerg Radiol 2012; 19: 293–99.CrossRefGoogle ScholarPubMed
46Basaran, A, Basaran, M. Diagnosis of acute appendicitis during pregnancy: a systematic review. Obstet Gynecol Surv 2009; 64: 481–88.CrossRefGoogle ScholarPubMed
47Masselli, G, Brunelli, R, Casciani, E, Polettini, E, Bertini, L, Laghi, Fet al.Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdom Imaging 2011; 36: 596–603.CrossRefGoogle ScholarPubMed
48Shellock, FG, Crues, JV. MR procedures: biologic effects, safety, and patient care. Radiology 2004; 232: 635–52.CrossRefGoogle ScholarPubMed
49Levine, D, Zuo, C, Faro, CB, Chen, Q. Potential heating effect in the gravid uterus during MR HASTE imaging. J Magn Reson Imaging 2001; 13: 856–61.CrossRefGoogle ScholarPubMed
50Clements, H, Duncan, KR, Fielding, K, Gowland, PA, Johnson, IR, Baker, PN. Infants exposed to MRI in utero have a normal paediatric assessment at 9 months of age. Br J Radiol 2000; 73: 190–94.CrossRefGoogle ScholarPubMed
51Baker, PN, Johnson, IR, Harvey, PR, Gowland, PA, Mansfield, P. A three-year follow-up of children imaged in utero with echo-planar magnetic resonance. Am J Obstet Gynecol 1994; 170: 32–33.CrossRefGoogle ScholarPubMed
52Kanal, E, Barkovich, AJ, Bell, C, Borgstede, JP, BradleyWG, Jr. WG, Jr., Froelich, JWet al.ACR guidance document for safe MR practices: 2007. Am J Roentgenol 2007; 188: 1447–474.CrossRefGoogle ScholarPubMed
53Patel, SJ, Reede, DL, Katz, DS, Subramaniam, R, Amorosa, JK. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 2007; 27: 1705–1722.CrossRefGoogle ScholarPubMed
54Katzberg, RW, McGahan, JP. Science to practice: Will Gadolinium–enhanced MR imaging be useful in assessment of at-risk pregnancies? Radiology 2011; 258: 325–26.CrossRefGoogle ScholarPubMed
55Lee, I, Chew, FS. Use of IV iodinated and gadolinium contrast media in the pregnant or lactating patient: Self-assessment module. Am J Roentgenol 2009; 193 (6 Suppl): S70–73.CrossRefGoogle ScholarPubMed
56Hlibczuk, V, Dattaro, JA, Jin, Z, Falzon, L, Brown, MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med 2010; 55: 51–59 e51.CrossRefGoogle ScholarPubMed
57Damilakis, J, Perisinakis, K, Voloudaki, A, Gourtsoyiannis, N. Estimation of fetal radiation dose from computed tomography scanning in late pregnancy: depth-dose data from routine examinations. Invest Radiol 2000; 35: 527–33.CrossRefGoogle ScholarPubMed
58Hurwitz, LM, Yoshizumi, T, Reiman, RE, Goodman, PC, Paulson, EK, Frush, DPet al.Radiation dose to the fetus from body MDCT during early gestation. Am J Roentgenol 2006; 186: 871–876.CrossRefGoogle Scholar
59Ray, JG, Schull, MJ, Urquia, ML, You, JJ, Guttmann, A, Vermeulen, MJ. Major radiodiagnostic imaging in pregnancy and the risk of childhood malignancy: a population-based cohort study in Ontario. PLoS Med 2010; 7: e1000337.CrossRefGoogle ScholarPubMed
60Simillis, C, Symeonides, P, Shorthouse, AJ, Tekkis, PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 2010; 147: 818–29.CrossRefGoogle ScholarPubMed
61Oliak, D, Yamini, D, Udani, VM, Lewis, RJ, Arnell, T, Vargas, Het al.Initial nonoperative management for periappendiceal abscess. Dis Colon Rectum 2001; 44: 936–41.CrossRefGoogle ScholarPubMed
62Liu, K, Fogg, L. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 2011; 150: 673–83.CrossRefGoogle ScholarPubMed
63Varadhan, KK, Neal, KR, Lobo, DN. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ 2012; 344: e2156.CrossRefGoogle ScholarPubMed
64Young, BC, Hamar, BD, Levine, D, Roque, H. Medical management of ruptured appendicitis in pregnancy. Obstet Gynecol 2009; 114: 453–56.CrossRefGoogle ScholarPubMed
65Fulton, MB, Fontenot, B, Leon, SM. Drainage with antibiotics is effective therapy for appendicitis in pregnancy. JAAPA 2010; 23: 29–31.CrossRefGoogle ScholarPubMed
66Affleck, DG, Handrahan, DL, Egger, MJ, Price, RR. The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg 1999; 178: 523–29.CrossRefGoogle ScholarPubMed
67Walsh, CA, Tang, T, Walsh, SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 2008; 6: 339–44.CrossRefGoogle ScholarPubMed
68Hodjati, H, Kazerooni, T. Location of the appendix in the gravid patient: a re-evaluation of the established concept. Int J Gynaecol Obstet 2003; 81: 245–47.CrossRefGoogle Scholar
69Gadacz, TR, Talamini, MA. Traditional versus laparoscopic cholecystectomy. Am J Surg 1991; 161: 336–38.CrossRefGoogle ScholarPubMed
70Curet, MJ, Allen, D, Josloff, RK, Pitcher, DE, Curet, LB, Miscall, BGet al.Laparoscopy during pregnancy. Arch Surg 1996; 131: 546–50.CrossRefGoogle ScholarPubMed
71Barnard, JM, Chaffin, D, Droste, S, Tierney, A, Phernetton, T. Fetal response to carbon dioxide pneumoperitoneum in the pregnant ewe. Obstet Gynecol 1995; 85 (5 Pt 1): 669–74.CrossRefGoogle ScholarPubMed
72Reedy, MB, Galan, HL, Bean-Lijewski, JD, Carnes, A, Knight, AB, Kuehl, TJ. Maternal and fetal effects of laparoscopic insufflation in the gravid baboon. J Am Assoc Gynecol Laparosc 1995; 2: 399–406.CrossRefGoogle ScholarPubMed
73Hunter, JG, Swanstrom, L, Thornburg, K. Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. Surg Endosc 1995; 9: 272–77.CrossRefGoogle Scholar
74Uemura, K, McClaine, RJ, de la Fuente, SG, Manson, RJ, Campbell, KA, McClaine, DJet al.Maternal insufflation during the second trimester equivalent produces hypercapnia, acidosis, and prolonged hypoxia in fetal sheep. Anesthesiology 2004; 101: 1332–338.CrossRefGoogle ScholarPubMed
75Pearl, J, Price, R, Richardson, W, Fanelli, R. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2011; 25: 3479–492.CrossRefGoogle ScholarPubMed
76Friedman, JD, Ramsey, PS, Ramin, KD, Berry, C. Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol 2002; 99: 512–13.Google ScholarPubMed
77Joumblat, N, Grubbs, B, Chmait, RH. Incidental fetoscopy during laparoscopy in pregnancy: management of perforation of the gravid uterus. Surg Laparosc Endosc Percutan Tech 2012; 22: e76–78.CrossRefGoogle ScholarPubMed
78Guidelines for laparoscopic surgery during pregnancy. Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Surg Endosc 1998; 12: 189–90.Google Scholar
79Jackson, H, Granger, S, Price, R, Rollins, M, Earle, D, Richardson, Wet al.Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 2008; 22: 1917–927.CrossRefGoogle ScholarPubMed
80Kirshtein, B, Perry, ZH, Avinoach, E, Mizrahi, S, Lantsberg, L. Safety of laparoscopic appendectomy during pregnancy. World J Surg 2009; 33: 475–80.CrossRefGoogle ScholarPubMed
81Park, SH, Park, MI, Choi, JS, Lee, JH, Kim, HO, Kim, H. Laparoscopic appendectomy performed during pregnancy by gynecological laparoscopists. Eur J Obstet Gynecol Reprod Biol 2010; 148: 44–48.CrossRefGoogle ScholarPubMed
82Wang, CJ, Yen, CF, Lee, CL, Soong, YK. Minilaparoscopic cystectomy and appendectomy in late second trimester. JSLS 2002; 6: 373–75.Google ScholarPubMed
83Gurbuz, AT, Peetz, ME. The acute abdomen in the pregnant patient. Is there a role for laparoscopy? Surg Endosc 1997; 11: 98–102.CrossRefGoogle Scholar
84Wu, JM, Chen, KH, Lin, HF, Tseng, LM, Tseng, SH, Huang, SH. Laparoscopic appendectomy in pregnancy. J Laparoendosc Adv Surg Tech A 2005; 15: 447–50.CrossRefGoogle ScholarPubMed
85Moreno-Sanz, C, Pascual-Pedreno, A, Picazo-Yeste, JS, Seoane-Gonzalez, JB. Laparoscopic appendectomy during pregnancy: between personal experiences and scientific evidence. J Am Coll Surg 2007; 205: 37–42.CrossRefGoogle ScholarPubMed
86de Bakker, JK, Dijksman, LM, Donkervoort, SC. Safety and outcome of general surgical open and laparoscopic procedures during pregnancy. Surg Endosc 2011; 25: 1574–578.CrossRefGoogle ScholarPubMed
87Koh, AR, Lee, JH, Choi, JS, Eom, JM, Hong, JH. Single-port laparoscopic appendectomy during pregnancy. Surg Laparosc Endosc Percutan Tech 2012; 22: e83–86.CrossRefGoogle ScholarPubMed
88Miloudi, N, Brahem, M, Ben Abid, S, Mzoughi, Z, Arfa, N, Tahar Khalfallah, M. Acute appendicitis in pregnancy: Specific features of diagnosis and treatment. J Visc Surg 2012; 49: e275–9. Epub 2012 Jun 28.CrossRefGoogle Scholar
89James, AH. Prevention and treatment of venous thromboembolism in pregnancy. Clin Obstet Gynecol 2012; 55: 774–87.CrossRefGoogle ScholarPubMed
90Jorgensen, JO, Lalak, NJ, North, L, Hanel, K, Hunt, DR, Morris, DL. Venous stasis during laparoscopic cholecystectomy. Surg Laparosc Endosc 1994; 4: 128–33.Google ScholarPubMed
91Nguyen, NT, Hinojosa, MW, Fayad, C, Varela, E, Konyalian, V, Stamos, MJet al.Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 2007; 246: 1021–1027.CrossRefGoogle ScholarPubMed
92Eom, JM, Hong, JH, Jeon, SW, Choi, JS, Lee, JH, Kim, HOet al.Safety and clinical efficacy of laparoscopic appendectomy for pregnant women with acute appendicitis. Ann Acad Med Singapore 2012; 41: 82–85.CrossRefGoogle ScholarPubMed
93Dasari, P, Maurya, DK. The consequences of missing appendicitis during pregnancy. BMJ Case Reports 2011;10.1136/bcr.05.2011.4185CrossRefGoogle ScholarPubMed
94Parker, RB. Acute appendicitis in late pregnancy. Lancet 1954; 266: 1252–257.CrossRefGoogle ScholarPubMed
95Silvestri, MT, Pettker, CM, Brousseau, EC, Dick, MA, Ciarleglio, MM, Erekson, EA. Morbidity of appendectomy and cholecystectomy in pregnant and nonpregnant women. Obstet Gynecol 2011; 118: 1261–270.CrossRefGoogle ScholarPubMed
96Terzi, A, Yildiz, F, Vural, M, Coban, S, Cece, H, Kaya, M. A case series of 46 appendectomies during pregnancy. Wien Klin Wochenschr 2010; 122: 686–90.CrossRefGoogle ScholarPubMed
97Wei, PL, Keller, JJ, Liang, HH, Lin, HC. Acute appendicitis and adverse pregnancy outcomes: a nationwide population-based study. J Gastrointest Surg 2012; 16: 1204–211.CrossRefGoogle ScholarPubMed
98Acs, N, Banhidy, F, Czeizel, AE. Primary microcephaly in two children born to mothers with complicated appendicitis or late appendectomy during pregnancy. Birth Defects Res A Clin Mol Teratol 2009; 85: 655–56.CrossRefGoogle ScholarPubMed
99Cohen-Kerem, R, Railton, C, Oren, D, Lishner, M, Koren, G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 2005; 190: 467–73.CrossRefGoogle ScholarPubMed
100Ito, K, Ito, H, Whang, EE, Tavakkolizadeh, A. Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 2012; 203: 145–50.CrossRefGoogle ScholarPubMed
101Choi, JJ, Mustafa, R, Lynn, ET, Divino, CM. Appendectomy during pregnancy: follow-up of progeny. J Am Coll Surg 2011; 213: 627–32.CrossRefGoogle ScholarPubMed
102Viktrup, L, Hee, P. Fertility and long-term complications four to nine years after appendectomy during pregnancy. Acta Obstet Gynecol Scand 1998; 77: 746–50.Google ScholarPubMed
103Machado, NO, Grant, CS. Laparoscopic appendicectomy in all trimesters of pregnancy. JSLS 2009; 13: 384–90Google ScholarPubMed