Drake Frederick T, Kotagal Meera, Simmons LaVone E, Parr Zoe, Dighe Manjiri K, Flum David R
Department of Surgery, University of Washington Medical Center , Seattle, WA , USA .
J Matern Fetal Neonatal Med. 2015 Apr;28(6):727-33. doi: 10.3109/14767058.2014.932344. Epub 2014 Jul 2.
Assess the performance of ultrasound (US) in pregnant patients presenting with acute abdominal pain concerning for appendicitis.
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.
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 (p < 0.001). Concordance between US and pathology was similar statewide and at our institution (43%).
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.
评估超声（US）在表现出疑似阑尾炎的急性腹痛孕妇中的应用效果。
利用来自全州质量改进协作组和单一中心的数据，对6年间因急性腹痛接受超声检查的孕妇进行描述性分析。
在全州范围内，131名孕妇接受了阑尾切除术，其中85%进行了超声检查。在我们的单中心病例系列中，49名孕妇因急性腹痛接受了超声检查，4名患者患有阑尾炎（8%）。其中，3名通过超声得到明确诊断。5名患者的阑尾通过超声可见（3例阑尾炎/2例正常）。阑尾可见时的平均孕周为11周，不可见时为20周（p < 0.001）。超声与病理结果的一致性在全州范围和我们机构相似（43%）。
超声似乎在评估孕妇阑尾炎方面发挥核心作用，尤其是在孕早期，并且常常有助于做出明确诊断。超声在排除阑尾炎方面表现欠佳；然而，在某些临床情况下，医生似乎信任超声检查结果。基于这些结果，我们为表现出疑似阑尾炎的急性腹痛孕妇制定了多学科成像路径。
