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Analyzing results of diagnostics and prediction of acute appendicitis in pregnant women: approaches to solving a well-known clinical problem
- Authors: Logvin L.A.1, Popov D.N.1, Kiseleva E.V.1, Korolkov A.Y.1, Bagnenko S.F.1
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Affiliations:
- Academician I.P. Pavlov First St. Petersburg State Medical University
- Issue: Vol 16, No 1 (2025)
- Pages: 35-45
- Section: Original studies
- URL: https://journals.eco-vector.com/pediatr/article/view/681694
- DOI: https://doi.org/10.17816/PED16135-45
- EDN: https://elibrary.ru/CPIDMU
- ID: 681694
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Abstract
BACKGROUND: Currently, despite the development of modern technologies, timely diagnosis of acute appendicitis in pregnant women still remains an important task. Early and correct diagnosis makes it possible to determine the necessary tactics and treatment, which minimizes possible complications and negative results of surgical interventions.
AIM: The aim of the study was to analyze medical histories and find a new approach in the diagnosis and treatment of acute appendicitis in pregnant women in the second and third trimesters of pregnancy.
MATERIALS AND METHODS: A retrospective analysis of medical records of pregnant patients (n=162) operated on with a diagnosis of acute appendicitis in the period from 2010 to 2019 was carried out. The study took into account epidemiological, clinical, paraclinical, operational and postoperative data. Statistical processing of the obtained data was carried out.
RESULTS: When conducting a comparative analysis, the most significant predictors of acute appendicitis in pregnant women were identified: the level of leukocytes in the blood ≥12.5×109/l [relative risk (RR) (confidence interval (CI)) 2.37 (1.47–3.80)], C-reactive protein ≥21.0 mg/l [RR (CI) 1.72 (1.36–2.17)], positive Kocher’s sign [RR (CI) 2.01 (1.50–2.69)], and percentage granulocyte count ≥78.0 [RR (CI) 2.2 (1.29–3.77)], and presence of nausea/vomiting [RR (CI) 1.35 (1.03–1.76)]. Based on the obtained data from univariate analysis, a decision tree diagram was developed to determine the risk of developing acute appendicitis. The proposed decision tree diagram has good sensitivity (65.9%) and specificity (92.1%) with AuROC=0.86.
CONCLUSIONS: The constructed diagnostic model can be used in clinical practice to determine the likelihood of acute appendicitis in pregnant women in the II–III trimesters of pregnancy, and the inclusion of magnetic resonance imaging can significantly improve the quality of acute appendicitis diagnosis, which requires further research in this direction.
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About the authors
Larisa A. Logvin
Academician I.P. Pavlov First St. Petersburg State Medical University
Author for correspondence.
Email: laralogvin@mail.ru
ORCID iD: 0009-0008-4997-9543
SPIN-code: 3932-5120
Surgeon of Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine
Russian Federation, Saint PetersburgDmitry N. Popov
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: dimtryp@gmail.com
ORCID iD: 0000-0001-6995-4601
SPIN-code: 3847-2304
MD, PhD, Assistant of the F.G. Uglov Hospital Surgery Department No. 2 with Clinic, Head of the Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine
Russian Federation, Saint PetersburgElena V. Kiseleva
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: cc221@yandex.ru
ORCID iD: 0000-0002-2830-1687
SPIN-code: 6680-4130
MD, PhD, Surgeon, Surgeon of Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine
Russian Federation, Saint PetersburgAndrey Yu. Korolkov
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: korolkov.a@mail.ru
ORCID iD: 0000-0001-7449-6908
SPIN-code: 7513-7648
MD, PhD, Dr. Sci. (Medicine), Professor, Head of the F.G. Uglov Hospital Surgery Department No. 2 with Clinic, Head of the Department of General and Emergency Surgery of the Research Institute of Surgery and Emergency Medicine
Russian Federation, Saint PetersburgSergey F. Bagnenko
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: rector@spb-gmu.ru
ORCID iD: 0000-0002-6380-137X
SPIN-code: 3628-6860
MD, PhD, Dr. Sci. (Medicine), Professor, Academician of the Russian Academy of Sciences, Rector
Russian Federation, Saint PetersburgReferences
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