How to Detect Appendicitis During Pregnancy

Medically reviewed by Lacy Windham, MD

Last Updated: July 19, 2022 References Approved

Appendicitis is inflammation of the appendix. It is the most common condition in pregnancy that requires surgery "as a cure," ^{[1]
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Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} and it occurs in about 1/1000 pregnancies. Pregnant women generally experience appendicitis during the first two trimesters of pregnancy; however, it can also occur in the last trimester. If you are pregnant and worried that you may have appendicitis, see your doctor right away.

Part 1

Part 1 of 3:

Recognizing the Symptoms of Appendicitis

1
Know the common symptoms of appendicitis. ^{[2]
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Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source} These include:
- abdominal pain often starting centrally near your belly button and gradually shifting over a few hours towards the right side (this is the most worrisome sign that likely indicates appendicitis)
- nausea and/or vomiting (beyond what you may have experienced in conjunction with pregnancy)
- fever
- lack of appetite.
2
Monitor any pain you feel. The most reliable sign of appendicitis is pain that starts out dull in and around your belly button and, after a few hours, shifts over to the right side and becomes more intense. ^{[3]
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Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source}
- The "classic" appendicitis pain is located two-thirds of the way between your belly button and your hip bone (this spot is called McBurney's Point). ^{[4]
  X
  Research source
  Kumar, P., & Clark, M. (2009). Kumar & Clark's Clinical Medicine 7th Edition. Philadelphia: Elsevier Limited.}
- If you have appendicitis and try to lie on the right side of your body, you will feel the pain more strongly. You may also feel pain when you stand or move.
- Some women experience pain when they stand because they have an overly stretched round ligament (something that can occur during pregnancy). However, that sort of pain goes away within a few moments. Appendix pain, on the other hand, does not go away, so this is how you can distinguish them.
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3
Be aware that you may feel pain higher up in your body if you are in your third trimester. Women who are 28 weeks pregnant and up will feel pain right under the lowest rib on their right side. This is because as your child and your womb grow, your appendix gets moved. Instead of it being located between your belly button and right hip (in McBurney's Point) it will move up your abdomen so that it is pushed right below the right side of your ribcage.
4
Pay attention if the pain you feel is followed by vomiting and nausea. As you most likely know, vomiting and pregnancy go hand-in-hand. However, if you have appendicitis, you will feel pain first and then you will vomit (or the nausea and vomiting will be worsened as compared to what they were previously). ^{[5]
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Research source
D.C. Dutta’s Textbook of Obstetrics, 7th edition. Jaypee publishers. India}
- Also, if you are later along in your pregnancy (after the initial vomiting stage has passed), nausea and vomiting are much more likely to indicate something else going on like appendicitis.
5
Be aware if you suddenly develop a fever. When you have appendicitis, a low grade fever usually develops. A low-grade fever by itself is not too much of a cause for alarm. However, it is really the combination of fever, pain, and vomiting that should concern you. If you experience all three of these symptoms at once, you should go see your doctor.^{[6]
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Research source
Sabaratnam Arulkumaran , Essentials of Obstetrics, 2nd edition. Jaypee publishers. India}
6
Monitor any paleness, sweating, or lack of appetite that you experience. Both sweating and paleness can be brought on by the nausea and fever you have when your appendix becomes inflamed. You will also lose your appetite - this happens to anyone experiencing appendicitis, regardless of whether they are pregnant or not.

Part 2

Part 2 of 3:

Undergoing a Physical Examination

1
Stay calm and prepare for the visit to your doctor. Going to the doctor, especially in a stressful situation like this one, can be nerve-wracking so it is best to know what you are going to experience. The abdominal exams your doctor will perform are listed in the following steps.^{[7]
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Trustworthy Source
Johns Hopkins Medicine
Official resource database of the world-leading Johns Hopkins Hospital
Go to source}
- It is best to see a doctor in the emergency room. Appendicitis is a condition that should be treated promptly if you have it, so it is recommended to be seen in the hospital where tests can be performed quickly if needed.
2
Avoid taking pain medications before going to see your doctor. While you will be experiencing pain, that pain is one of the only ways doctors can diagnose appendicitis in pregnant women so masking it with medication could be detrimental.^{[8]
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Trustworthy Source
Johns Hopkins Medicine
Official resource database of the world-leading Johns Hopkins Hospital
Go to source}
3
Do not eat, drink, or take any laxatives before seeing your doctor. Most people see a physician in the emergency room when they are worried about appendicitis, so the wait shouldn't be too long.
- The reason refraining from eating and drinking is important is that an empty stomach is required for certain procedures done by doctors. Also, it is easier on your digestive tract and reduces the chance of your appendix bursting if you do in fact have appendicitis.
4
Know that your doctor will feel around your stomach testing for pain. There are a variety of tests doctors perform in order to determine the cause of abdominal pain to figure out whether or not it is appendicitis. These include pressing around your abdomen to elicit painful areas, as well as tapping and testing for "rebound tenderness" (pain after they release the pressure of their hand). ^{[9]
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Research source
D.C. Dutta’s Textbook of Obstetrics, 7th edition. Jaypee publishers. India}
- The tests may seem redundant and time-consuming, but know that these can be very helpful to your doctor in figuring out exactly what is going on.
5
Be prepared for a rotation of the hip test. This test will look for the "Obturator sign," which is pain that occurs when your hip is rotated. Your doctor will hold on to your right knee and ankle and then bend your hip and knee while rotating your leg inwards and outwards. Pay attention to any pain you feel in your lower right quadrant of your abdomen - tell your doctor if you feel pain in that area because it could mean that there’s an irritation of the obturator muscle happening, which is a sign of appendicitis.^{[10]
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Research source
Sabaratnam Arulkumaran , Essentials of Obstetrics, 2nd edition. Jaypee publishers. India}
6
Expect a leg extension test. Your doctor will ask you to lie on your side, and he or she will extend your leg asking if you feel pain. This is called the "Psoas test" and, when positive for increased pain, it is another indicator of appendicitis. ^{[11]
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Trustworthy Source
National Institute of Diabetes and Digestive and Kidney Diseases
Health information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of Health
Go to source}
7
Be ready for a rectal exam. Although the rectal exam does not relate directly to the diagnosis of appendicitis, many physicians have been trained to do it as a way to exclude the possibility of something else going on. So do not be surprised if this occurs during the visit with your physician. ^{[12]
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Trustworthy Source
National Institute of Diabetes and Digestive and Kidney Diseases
Health information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of Health
Go to source}

Part 3

Part 3 of 3:

Using Medical Tests to Confirm the Diagnosis

1
Be ready to get some blood work done. Your white blood cell counts are usually elevated with appendicitis. However, this test is less helpful in pregnant women than in other patients; this is because your white blood cell counts are already increased in pregnancy, so it does not necessarily indicate appendicitis.^{[13]
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Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source}
2
Ask your doctor for an ultrasound. Ultrasound is the "gold standard" (most highly recommended) diagnostic test for appendicitis in pregnant women. ^{[14]
X
Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} It uses ultrasound echoes to create a picture and to help doctors see if you have an inflamed appendix. ^{[15]
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Research source}
- Generally people who come into the ER with suspected appendicitis receive a CT scan. However, most doctors prefer ultrasound in pregnant women because it won't cause harm to your baby. ^{[16]
  X
  Research source
  Schwartz ‘s, Principles of Surgery, 9th edition. Mc graw hill. New-york}
- Ultrasounds can successfully detect the majority of cases of appendicitis.^{[17]
  X
  Trustworthy Source
  PubMed Central
  Journal archive from the U.S. National Institutes of Health
  Go to source}
3
Be open to the possibility of other imaging tests. After 35 weeks of pregnancy, all imaging tests become complicated because of the size of the pregnancy making it hard to see the appendix.
- At this point, your doctor may recommend a CT scan or an MRI to better visualize the appendix to see if it is inflamed. ^{[18]
  X
  Trustworthy Source
  Cleveland Clinic
  Educational website from one of the world's leading hospitals
  Go to source}

Warnings

Pregnant patients with appendicitis can be tricky to diagnose, as the location of pain may not be in the traditional place.

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If you have a ruptured appendix that happens during your third trimester, you may have to have a caesarean section operation to make sure that both you and your baby are safe. At this point, the baby is old enough to be delivered and is okay to be living in the outside world.

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If you are feeling sharp pain that will not go away, go to the emergency room. It is always best to consult an experienced physician to determine what is going on.

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