Acute appendicitis during pregnancy: a case-control study

Background Acute appendicitis is the most common non-obstetric surgical emergency in pregnancy. Diagnosis is difficult due to atypical symptoms, anatomical changes, and limited imaging utility, while delayed diagnosis increases maternal-fetal risks. This study compared clinical, laboratory, imaging and perioperative outcomes between pregnant and non-pregnant women. Methods This analysis included a multi-centered retrospective case-control study from July 1, 2020 to December 30, 2025. The operative characteristics involved in the pregnancy women were investigated using univariate analyses. Results There were 99 pregnant women and 186 non-pregnant reproductive-age women underwent surgery enrolled in this research. Pregnant patients had lower right lower quadrant tenderness ( P = 0.046) and lower ultrasound sensitivity (46.5% vs. 53.2%). MRI showed 100% diagnostic accuracy. Pregnant women had higher open conversion rate ( P < 0.001), longer hospital stay ( P = 0.0056) and higher histologically negative appendectomies (14.1% vs. 9.7%, P < 0.001). Laparoscopic rate decreased with gestational age. Most complications were minor. Conclusion Acute appendicitis in pregnancy presents atypically with lower ultrasound sensitivity. MRI improves diagnostic accuracy. Laparoscopic appendectomy is safe and feasible in pregnancy.