Diagnosis of Acute Appendicitis During Pregnancy

Objective: To perform a systematic review to evaluate the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) for the diagnosis of appendicitis in pregnancy. Data Sources: A systematic literature search of MEDLINE from 1966 through August 2008, MEDION database, OVID MEDLINE from 1950 through August 2008, and bibliographies of review articles and eligible studies. Methods of Study Selection: Three articles related to the use of CT and 5 to the use of MRI for the diagnosis of acute appendicitis during pregnancy were identified. All of the identified studies were retrospective. Findings were compared to surgical pathology and/or clinical follow-up. Results were pooled using the Mantel–Haenszel fixed-effects model and the DerSimonian–Laird random-effects model. Tabulation, Integration, and Results: The pooled estimates of sensitivity and specificity, positive and negative likelihood ratios for the performance of CT in patients with prior normal/inconclusive ultrasonography result were 85.7% (95% CI: 63.7%–97%) and 97.4% (95% CI: 86.2%–99.9%), 10.1 (95% CI: 3.4–30.1), and 0.21 (95% CI: 0.05–0.88), respectively. The pooled estimates of sensitivity and specificity, positive and negative likelihood ratios for performance of MRI in patients with prior normal/inconclusive ultrasonography result were 80% (95% CI: 44%–98%) and 99% (95% CI: 94%–100%), 22.7 (95% CI: 6.0–87.5), and 0.29 (95% CI: 0.13–0.68), respectively. Conclusion: This review is limited by the small number and retrospective nature of the available studies. With these limitations in mind, CT and MRI seem to be highly sensitive and specific for the diagnosis of appendicitis in pregnancy and their use should be considered when the results of ultrasonography are normal or inconclusive and appendicitis is suspected. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to recall the obstacles to correct diagnosis of appendicitis in pregnancy, compare the advantages and disadvantages of magnetic resonance imaging and computed tomography in the evaluation of the gravid patient with suspected appendicitis, and state the risks to a pregnant patient and her fetus with appendicitis in pregnancy.