Department of Gynecology and Obstetrics, Zabol University of Medical Sciences, Zabol, Iran.
Department of Medicine, Zabol University of Medical Sciences, Zabol, Iran.
Emerg Radiol. 2022 Jun;29(3):437-448. doi: 10.1007/s10140-022-02021-9. Epub 2022 Feb 12.
Lack of timely diagnosis of acute appendicitis (AA) can lead to perforation and peritonitis, which might be associated with complications such as miscarriage, preterm delivery, fetal loss, and even maternal mortality. The aim of the present systematic review and meta-analysis was to evaluate the accuracy of ultrasonography (US) for diagnosing AA in pregnant patients.
We performed the present systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Using a pre-designed standard datasheet, the two authors summarized the data of each study independently. Pregnant women with diagnosed or suspected AA, who have undergone ultrasonography, as well as using CT scan or surgery as the standard method, were included.
A total of 8 studies consisting of 1593 patients were included. The main analysis showed that the overall sensitivity and specificity were 77.6% and 75.3% for US in diagnosing AA in pregnancy. The sensitivity of US in the first, second, and third trimesters of pregnancy were 69%, 63%, and 51%, respectively. While the corresponding figures for specificity were 85%, 85%, and 65%. There was a significant difference in the diagnostic performance of US between the first two trimesters and the third one. The DORs in these three trimesters were 36, 26, and 1.92, respectively.
Ultrasound evaluation showed a low diagnostic accuracy for acute appendicitis in pregnant women, especially during the third trimester. These patients should be diagnosed early and accurately to prevent both complications and unnecessary operations. It can be recommended to consider alternative imaging, mostly after negative or uncertain US.
急性阑尾炎（AA）的诊断不及时可能导致穿孔和腹膜炎，这可能与流产、早产、胎儿丢失，甚至产妇死亡等并发症有关。本系统评价和荟萃分析的目的是评估超声（US）诊断孕妇 AA 的准确性。
我们根据系统评价和荟萃分析的首选报告项目（PRISMA）进行了本次系统评价和荟萃分析。使用预先设计的标准数据表，两位作者独立总结了每项研究的数据。纳入了诊断或疑似 AA 的孕妇，以及使用 CT 扫描或手术作为标准方法的孕妇。
共有 8 项研究，共 1593 名患者纳入了本次分析。主要分析显示，US 诊断妊娠时 AA 的总体敏感性和特异性分别为 77.6%和 75.3%。US 在妊娠第一、第二和第三孕期的敏感性分别为 69%、63%和 51%，而特异性分别为 85%、85%和 65%。US 在妊娠前两个孕期和第三个孕期的诊断性能存在显著差异。这三个孕期的 DOR 分别为 36、26 和 1.92。
超声评估显示孕妇急性阑尾炎的诊断准确性较低，尤其是在妊娠晚期。这些患者应尽早准确诊断，以防止并发症和不必要的手术。可以建议考虑替代成像，尤其是在阴性或不确定的 US 之后。
