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| Reference | Type of study | Pain location/other symtoms | Trimester | Management | Maternal outcomes | Fetal or neonatal outcomes |
|
| Babler 1908 [19] | Case report | Sudden, progressive, severe right lower abdominal pain becoming excruciating associated with vomiting | Third (30 weeks) | Open surgery | Perforated appendix;
large appendiceal abscess (discharged on postoperative D35);
phlebitis in the left thigh (1 week after discharge) | Preterm labor (D2) |
| Tamir et al. 1990 [15] | Case series (84 patients; 54 patients with appendicitis pathologically confirmed) | Diffuse or periumbilical pain migrating to the right lower abdominal quadrant (48%); right lower quadrant pain only (28%); nausea/vomiting (91/81%); anorexia (70%); diarrhea (31%); constipation (4%) | First (32%); second (44%); third (16%) | Open surgery: right transverse muscle-spitting incision over the point of maximum tenderness (79%); low midline vertical incisions (13%); laparoscopic surgery: completed (1%), initially underwent diagnostic laparoscopy (4%) in the first trimester | Confirmed appendicitis:
perforation rate: 43% (all with symptoms >24 h);
periappendiceal or pelvic abscess: 22%;
wound infection: 13% (11% perforated);
no long-term maternal morbidity or mortality | Spontaneous abortion (2%);
preterm labor (27%); failure of tocolysis (5%); Apgar score at 5 min <7 (5%);
negative laparotomies: perinatal death (17%); extreme perinatal morbidity (3%) |
| Turnock et al. 2016 [31] | Case report | Progressive right/left lower and right upper quadrant abdominal pain associated with dysuria, nausea, and vomiting with oral intolerance in the previous 5 days | Second (15 weeks) | Laparoscopic approach with conversion to laparotomy (due to massive bowel distention and purulent ascites); temporary abdominal closure due to acute compartment syndrome with saline-dampened surgical towel placed over cassette cover;
peritoneal toilet with inspection of the ileocolic anastomosis (D4); fascial closure (D6); delayed primary closure of the laparotomy incision (D12) | Ileocecum abscess; perforation of the appendiceal base with extension into the cecum;
cecal necrosis (discharged on postoperative D15); no surgical complications at 5 years postdelivery | Term spontaneous vaginal delivery; child obtained all developmental milestones |
| Tase et al. 2017 [4] | Systematic review (43 articles) | Right lower quadrant pain (60-100%); nausea, vomiting, and anorexia common and indistinguishable from pregnancy related symptoms | First (30%); second (45%); third (25%) | Both open and laparoscopic surgery safe without statistically significant difference in perioperative obstetric or neonatal outcomes; no advisable medical management due little evidence on safety | Perforation rate: 20.3-43% (66% if delay in surgery >24 h; 8.7% first trimester, 12.5% second trimester, 26.1% third trimester) | Fetal loss: 1.5% delayed diagnosis, nonperforated; 35-55% delayed diagnosis, perforated appendix;
delivery rate: 15-45% (preterm labor highest in the first week following surgery) |
| Hata et al. 2020 [32] | Case report | Acute epigastralgia, followed by right lower abdominal pain and vomiting | Third (27 weeks) | Laparoscopic surgery with reduced-port approach | None (discharged on postoperative D8) | Vaginal delivery at term |
| Tavakoli et al. 2020 [33] | Case report | Acute onset of sharp right abdominal pain associated with nausea and a single episode of vomiting | Third (37 weeks) | Conservative: intravenous antibiotics with complete resolution of abdominal pain; induction of labor (D3) | None (patient’s pain and clinical status stable on D3 and discharged on postoperative D6 with a 10-day course of oral antibiotic; patient denied elective appendectomy at 20-months) | Uncomplicated vaginal delivery (D4) |
| Matsui et al. 2020 [34] | Case report | Diffuse abdominal pain migrating to the right lower abdominal quadrant started the day before admission | Second (20 weeks; dichorionic diamniotic twin pregnancy) | Laparoscopic surgery (3 trocars; insufflation pressure 10 mm Hg; left lateral tilt; ultrasonic energy) | None (discharged on postoperative D9) | Uncomplicated elective cesarean section (38 weeks) |
| Saleh et al. 2020 [35] | Case report | Persistent, severe, exacerbated by movement lower abdominal pain associated with loss of appetite in the previous 2 days | Second (17 weeks) | Laparoscopic surgery | Acute, nonperforated appendix;
pelvic abscess;
peritoneovaginal fistula (discharged on postoperative D5; endometriosis and decidualization on pathological
examination of the appendix) | Uncomplicated spontaneous vaginal delivery (40 1/7 weeks) |
| Ghannouchi et al. 2021 [36] | Case report | Right iliac fossa pain in the previous 2 days | Third (32 weeks) | Planned appendectomy | None (discharged on postoperative D2; appendicular deciduosis on microscopical examination) | Uncomplicated delivery (39 weeks) |
| Sanders-Davis et al. 2021 [37] | Case report | Generalized abdominal pain migrating to right lumbar region associated with loss of appetite and vomiting;
no respiratory symptoms (PCR SARS-CoV-2 infection positive) | Third (33 1/7 weeks) | Open surgery: right-sided transverse incision guided by the available imaging to allow access to the cranially displaced appendix | Perforated appendix with local peritonitis
(worsening respiratory function after appendectomy with a diagnosis of bilateral pneumonia; discharged on postoperative D7) | Emergent cesarean section (33 6/7 weeks); neonatal respiratory distress syndrome with oxygen requirement at high pressures on mechanical ventilation, extubated at 24 hours of age (PCR SARS-CoV-2 negative at D3 and D5) |
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