Single institution and statewide performance of ultrasound in diagnosing appendicitis in pregnancy. (April 2015)

• Record Type: Journal Article
• Authors: Drake, Frederick T.; Kotagal, Meera; Simmons, LaVone E.; Parr, Zoe; Dighe, Manjiri K.; Flum, David R.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 28:Number 6(2015)
• Page Start: 727
• Page End: 733
• Publication Date: 2015-04
• Subjects: Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.3109/14767058.2014.932344
• Languages: English
• ISSNs: 1476-7058

Abstract

<abstract> <title>Abstract</title> <p> <italic>Objective</italic>: Assess the performance of ultrasound (US) in pregnant patients presenting with acute abdominal pain concerning for appendicitis.</p> <p> <italic>Methods</italic>: Descriptive analysis of pregnant patients who underwent an US for acute abdominal pain over a 6-year period using data from a statewide quality improvement collaborative and a single center.</p> <p> <italic>Results</italic>: Statewide, 131 pregnant patients underwent an appendectomy and 85% had an US. In our single-center case series, 49 pregnant patients underwent an US for acute abdominal pain and four patients had appendicitis (8%). Of those, three were definitively diagnosed with US. The appendix was visualized by US in five patients (3 appendicitis/2 normal). Mean gestational age was 11 weeks for visualization of the appendix versus 20 weeks for non-visualization (<italic>p</italic> < 0.001). Concordance between US and pathology was similar statewide and at our institution (43%).</p> <p> <italic>Conclusions</italic>: US appears to play a central role in the evaluation of appendicitis in pregnant women, especially in the first trimester, and often contributes to definitive disposition. US performed less well in excluding appendicitis; however, in certain clinical settings, providers appeared to trust US findings. From these results, we developed a multidisciplinary imaging pathway for pregnant patients who present with acute abdominal pain concerning for appendicitis.</p> </abstract>