Appendicitis is inflammation of the appendix (appendix). Appendicitis is the most common condition in pregnancy that requires surgery "as a cure", and occurs in 1 in 1000 pregnancies. Pregnant women usually develop appendicitis in the first two trimesters of pregnancy; however, it can also occur in the last quarter. Immediately visit a doctor if you are worried about having appendicitis during pregnancy.
Part 1 of 3: Recognizing the Symptoms of Appendicitis
Step 1. Know the common symptoms of appendicitis
These symptoms include:
- Pain in the abdomen, usually starting in the center near the navel and slowly moving to the right side within a few hours (this is the most worrying symptom which tends to indicate appendicitis)
- Nausea and/or vomiting (more than the nausea you might experience from pregnancy)
- Decreased appetite.
Step 2. Observe any pain you feel
The most accurate symptom of appendicitis is pain that starts to fade in and around the belly button, then shifts to the right side and gets stronger after a few hours.
- “Classic” appendicitis pain is located at two-thirds of the distance between the navel and the hipbone (this area is known as the McBurney Point).
- If you have appendicitis and try to lie on your right side, you will feel more severe pain. In addition, pain is also felt when standing or moving.
- Some women feel pain when standing because they have a round ligament disorder (something that can happen during pregnancy) that is too stretched. However, the pain due to the round ligament will stop after a while. On the other hand, the pain of appendicitis will not go away, so this is a good way to differentiate between the two.
Step 3. Be aware that you may experience more intense pain in your body if you are in your third trimester of pregnancy
Women who are 28 weeks pregnant or more will feel pain just below the right side of the lowest rib. This is because the appendix moves when the baby and uterus grow bigger. Instead of being located below the navel and to the right of the hip (McBurney Point), the appendix will move up the abdomen so that it is pushed just below the right side of the rib cage.
Step 4. Notice if the pain is followed by nausea and vomiting
As is known, vomiting and pregnancy are related. However, you will feel pain first and then vomiting (or nausea and vomiting worse than before) when you have appendicitis.
In addition, nausea and vomiting tend to indicate other medical conditions, such as appendicitis, if they are in the later stages of pregnancy (after the vomiting stage in early pregnancy has passed)
Step 5. Watch out for a sudden fever
A low-grade fever usually occurs when you have appendicitis. A low-grade fever that is not accompanied by other symptoms is not a cause for concern. However, the combination of fever, pain, and vomiting is really something to worry about. See a doctor if you experience all three of these symptoms at the same time.
Step 6. Observe any pallor, sweating, or decreased appetite experienced
Pale and sweaty face can occur due to nausea and fever experienced when the appendix is inflamed. You will also lose your appetite - this happens to everyone who has appendicitis, whether pregnant or not.
Part 2 of 3: Undergoing Physical Examination
Step 1. Stay calm and get ready to visit the doctor
Visiting a doctor, especially in a difficult situation like this, can be stressful so it's better to know what you're going through beforehand. The abdominal examination that will be performed by the doctor is listed in the steps below.
Better to visit a doctor in the ER. Appendicitis is a condition that must be treated quickly, so it is highly recommended to visit a hospital that can immediately perform an abdominal examination if necessary
Step 2. Avoid taking painkillers before visiting the doctor
Although painful, the pain is the only way a doctor can diagnose appendicitis in a pregnant woman, so hiding it with medication will only be self-defeating.
Step 3. Do not eat, drink, or use any type of laxative before seeing a doctor
Most people visit a doctor in the ER when they are concerned about appendicitis, so the waiting time shouldn't be too long.
The reason for refraining from eating and drinking is very important because an empty stomach is needed for certain procedures that will be carried out by doctors. In addition, refraining from eating and drinking will make the digestive system work easier and reduce the chance of the appendix bursting, if the patient does have appendicitis
Step 4. Know that the doctor will feel the area around the abdomen to test for pain
There are various kinds of examinations that the doctor will do to determine the cause of abdominal pain, to find out whether the patient has appendicitis or not. The examination includes pressing the area around the abdomen to find the area of pain, as well as patting and testing for “rebound tenderness” or “pain release” (pain after releasing pressure from the hand).
An abdominal examination may seem pointless and a waste of time, but know that this series is very helpful for the doctor in determining the actual condition
Step 5. Prepare for rotation on the pelvic exam
This examination will look for the “Obturator sign”, which is pain that occurs when the pelvis is rotated. The doctor will hold on to the right knee and ankle, then bend the hip and knee while rotating the leg in and out. Watch for any pain in the right lower quadrant of the abdomen - tell the doctor if the area is painful as this indicates irritation of the obturator muscle, which is a symptom of appendicitis.
Step 6. Understand the leg extension test
The doctor will ask the patient to lie on one side of the body, then he will pull the leg while asking if the patient feels pain. This procedure is called the “Psoas test”, and is another indicator of appendicitis when there is an increase in pain during the examination.
Step 7. Prepare for an anal exam
Although rectal examination is not directly related to the diagnosis of appendicitis, many doctors are trained to do it as a way to rule out other possible medical conditions. So, do not be surprised if this examination is done when you see a doctor.
Part 3 of 3: Using Medical Examination to Confirm the Diagnosis
Step 1. Get ready for a blood test
The white blood cell count is usually elevated when you have appendicitis. However, this test is not as useful in pregnant women as in other patients; This is because the white blood cell count has increased during pregnancy, so it doesn't always indicate appendicitis.
Step 2. Have the doctor perform an ultrasound (ultrasound)
Ultrasound is the “gold standard” diagnostic test for appendicitis in pregnant women. The ultrasound procedure uses reflected ultrasonic sound waves to produce images and help doctors see if the appendix is inflamed.
- Patients who come to the ED with suspicion of appendicitis generally receive a CT scan. However, most doctors prefer ultrasound to examine pregnant women because it is not harmful to the baby in the mother's womb.
- Ultrasound procedures are successful in detecting most cases of appendicitis.
Step 3. Be open to the possibility of other imaging tests
After 35 weeks of gestation, all imaging tests become difficult because the size of the baby and the growing uterus makes the test kit unable to see the appendix clearly.
At this point, the doctor may recommend a CT scan or MRI procedure for a clearer picture of the appendix, to see if there is inflammation or not
- Any unexplained pain or fever during pregnancy should be evaluated, or at least discussed with a doctor. Mother and child clinics generally have a doctor or midwife on standby who is connected to a 24-hour telephone service to answer questions about this.
- Observe the symptoms from time to time, because the most obvious characteristic of appendicitis is abdominal pain that starts around the navel and slowly moves to the right side.
- Stay calm and take your partner with you when you go to the clinic or hospital, so they can take your mind off it until it's time to see the doctor.
- If you experience a ruptured or leaking appendix during the third trimester, a cesarean section may be necessary to ensure that you and your baby are safe. At this point, the baby is mature enough to be born and can live outside the womb.
- Patients with appendicitis who are pregnant can be difficult to diagnose, because the pain may not occur in usual places.
- Go to the ER if you feel a sharp pain that doesn't go away. Consulting a doctor about a medical condition is the best way to find out what's really going on.