Mohammad Saddique, Pervez Iqbal, Asifa Ghazi.
Appendicitis in Pregnancy; does modified Alvarado score have a predictive value.
Pak J Surg Jan ;25(1):25-8.

Objective: To assess the predictive value of Modified Alvarado score for pregnant patients for early diagnosis of acute appendicitis in pregnancy. Study Design: Case series. Setting & Duration: Department of Gynaecology and Obstetric Unit III, Surgical Unit IV of Civil Hospital and a local private hospital at Karachi from February 2005 to December 2006 Methodology: Twenty eight patients with right lower quadrant abdominal pain during pregnancy and operated for acute appendicitis were included in the study. Patients with other causes of acute abdomen were excluded. Modified Alvarado score for pregnant patients was designed and proforma was filled for all patients. This being new study management was planned on clinical ground and not affected by the recorded score. Open or laparoscopic appendectomy was done according to patient preference and subject to availability offacility. Maternal and foetal morbidity and mortality were evaluated till parturition. Results: Among twenty eight pregnant patients that underwent appendectomy youngest was 18 year and oldest 38 year of age. Maximum number of patients 12(42.991o) were in second trimester. Positive predictive value of Modified Alvarado score for pregnant patients was 60% in score range of 5-7 and 100% in score range of 7-9. Three patients in 1st trimester and two in 2nd trimester opted for laparoscopic appendicectomy and remaining 23 had open appendicectomy. Two patients developed wound infection. One patient in laparoscopic group and other in open appendicectomy group developed preterm labour, capsule Nifedipine was used as tocolytic agent. No maternal or foetal mortality occurred in the study. Conclusion: Alvarado score increases the diagnostic yield of clinical examination in cases of acute appendicitis.

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