PERIOPERATIVE MANAGEMENT OF AN ABDOMINAL EMERGENCY IN A PREGNANT PATIENT OUTSIDE THE OBSTETRICAL SETTING

Acute appendicitis can complicate 1 in 500 to 2000 pregnancies, and can adversely affect maternal and fetal outcomes when the diagnosis and management are delayed. We report the case of a 31 years old prime gravid patient with a gestational age presenting with an acute abdomen evoluating for five days in a non obstetrical hospital. The diagnosis of acute perforated appendicitis with acute intestinal occlusion was made. The patient was treated surgically with hemodynamic, respiratory and metabolic optimization. Fetal well-being was monitored intermittently using point of care fetal ultrasound, by measuring fetal heart rate (FHR) with M-mode on the fetal heart. The patient was transferred shortly after stabilization to a maternal care facility. This case reports highlights diagnostic challenges associated with acute appendicitis in pregnancy, perioperative management and monitoring options outside the obstetrical setting, and the importance of an early transfer to a maternal critical care department.