Complaints during pregnancy about the appearance of acute pain in the right lower quadrant of the abdomen are perceived by a doctor of any profile with great concern and concern.
In this case, pain can have different causes: diseases of the gastrointestinal tract, gynecological and obstetric, and also be caused by diseases of the urinary system. However, in all these situations, the cause due to the development of acute appendicitis must be excluded, primarily because this is the most common cause of surgical intervention during pregnancy, which requires urgent measures.
Read the article on estet-portal.com modern approaches to the safe diagnosis of appendicitis during pregnancy.
Frequency of appendicitis during pregnancy
The incidence of acute appendicitis during pregnancy is 1: 1250 × 1: 1500. Usually, the traditional diagnostic program does not shine with high accuracy, which creates certain clinical difficulties at the stage of establishing a diagnosis and making a final decision on further treatment tactics.
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As the gestational age increases, the accuracy of the diagnosis decreases, becomes significantly worse, and the likelihood of threatening complications due to perforation of the appendix increases significantly.
This gives the surgeons a reason to sometimes unjustifiably decide to perform an operative intervention in case of only suspected acute appendicitis.
This has led to the fact that the frequency of unjustified laparotomy in obstetric practice is 25-50% and 15-35% in general surgery. This situation has prompted a search for methods to improve the quality of diagnostic search in number using modern imaging techniques.
Interferon effects and risks of complications during pregnancy
Comparison of the safety of methods for diagnosing appendicitis during pregnancy
Comparative analysis of the use of computed tomography (CT) and ultrasound diagnostics (ultrasound) to detect signs of acute appendicitis in pregnant women indicates a significantly higher information content of CT examination. However, despite such convincing results, even today ultrasound is one of the main diagnostic priority measures, primarily due to availability and safety. Due to the harmful effects of ionizing radiation on the fetus, CT examination remains an option for complex cases, as well as in the case when ultrasound examination is of little information and the situation is critical.
One of the modern imaging methods, where there is no such negative factor as ionizing radiation, and the information content of the obtained study exceeds the accuracy of CT examination and ultrasound, is magnetic resonance imaging (MRI). The only drawback, which is a deterrent to its wide clinical application, is the high cost of examinations and the low provision of medical institutions with devices. However, the American College of Radiology has approved an MRI examination as the recommended diagnostic approach for diagnosing acute appendicitis in pregnant women.
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Precisely in order to confirm the high clinical efficacy of the use of MRI examination in pregnant women with suspected acute appendicitis, a group of specialists led by Mania Kave conducted a systematic review and meta-analysis of primary literature sources in order to study the sensitivity, specificity and diagnostic accuracy of MRI examination during pregnancy for suspected appendicitis.
The results of a study on the safety of MRI diagnostics of appendicitis during pregnancy
The above analysis allowed us to confirm the high efficiency of the clinical use of MRI examination during pregnancy to exclude or confirm acute appendicitis. At the same time, CT examination should be used only in emergency cases when MRI is not available. To reduce the harmful effects of ionizing radiation, every possible means should be used to minimize it. In this case, it is useful to apply the methodology for minimizing the harmful effects of ionizing radiation (ALARA).
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During pregnancy, MRI does not require the use of gadolinium-containing contrast, without losing the information content of the examination, which also provides for the use of MRI in obstetric practice for the diagnosis of non-obstetric pain. At the same time, unlike a CT examination, MRI allows you to obtain high-definition images of soft tissues.
Thus, the authors draw the following conclusions:
1. MRI has high sensitivity and specificity (91.8 and 97.9% respectively) for the diagnosis of acute appendicitis during pregnancy at the stage of clinical clarification.
2. The method makes it possible to conduct this type of high-quality examination in almost all, without exception, situations, without the risk of harming the fetus or mother, and makes it an indispensable diagnostic method for confirming the diagnosis of acute appendicitis in pregnant women.
3. MRI can be performed during any period of pregnancy, without any risk of negative effects of ionizing radiation on the fetus.
Studies confirm the effectiveness of MRI diagnostics during pregnancy without the risk of fetal complications.
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