The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis.

OBJECTIVE: Accurate diagnosis of acute appendicitis in pregnancy by clinical evaluation is difficult. A safe, reliable test was sought to decrease a delay in diagnosis and to avoid unnecessary invasive procedures. A helical or spiral computed tomographic technique has proven to be a very accurate test in the nonobstetric population for the identification of acute appendicitis. We report its use in pregnant patients with suspected acute appendicitis. STUDY DESIGN: All pregnant patients who were undergoing helical computed tomography at our institution from April 1997 to February 1998 for the suspected clinical diagnosis of acute appendicitis were retrospectively reviewed. Helical computed tomography was performed by standard departmental protocol. A positive study was reported if an enlarged appendix, which did not fill with contrast material, was present with periappendiceal inflammatory changes. Outcomes were determined by the results of surgery and pathologic examination or clinical follow-up. RESULTS: Seven patients were identified in the study period. Two patients had positive findings on helical computed tomography, and acute appendicitis was confirmed at laparotomy and by pathologic inspection. There were no further prenatal complications and both patients delivered at term. Five patients had a normal-appearing appendix on helical computed tomography, and all of these patients had resolution of their pain and symptoms. CONCLUSION: Helical computed tomography appears to be a useful, noninvasive test to accurately diagnose acute appendicitis in pregnancy.

Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management.

OBJECTIVE: Our goal was to compare the pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy managed expectantly with antepartum testing with those of other patients who were followed up with a similar testing scheme. STUDY DESIGN: Cases of intrahepatic cholestasis of pregnancy monitored with antepartum testing at our institution over a 7-year period were reviewed. Their pregnancy outcomes were compared with those of control patients followed up with the same testing scheme for a history of stillbirth. Both groups had at least weekly nonstress tests and amniotic fluid assessment until spontaneous labor or delivery for standard obstetric indications RESULTS: Seventy-nine patients were analyzed in each group. The two groups did not differ with respect to the mean gestational age at delivery (38.5 vs 38.8 weeks), birth weight (3216 vs 3277 gm) or incidence of preterm delivery (14% vs 7.6%). Abnormal antepartum testing prompting delivery was more common in the control group (25% vs 7.6%, p < 0.05). The risk of meconium passage was higher in the cholestasis group (44.3% vs 7.6%, p < 0.05). Two antepartum fetal deaths occurred in the cholestasis group at 36 to 37 weeks' gestation within 5 days of normal results of antepartum testing. Thick meconium and appropriate birth weight were noted in both infants. No gross anomalies were found in either infant. CONCLUSION: Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcome not predicted by conventional fetal surveillance.