Pediatrician (St. Petersburg)Pediatrician (St. Petersburg)Педиатр2079-78502587-6252Eco-Vector68169410.17816/PED16135-45CPIDMUOriginal studiesОригинальные статьиResearch ArticleAnalyzing results of diagnostics and prediction of acute appendicitis in pregnant women: approaches to solving a well-known clinical problemАнализ результатов диагностики и прогнозирования острого аппендицита у беременных: подходы к решению известной клинической проблемыhttps://orcid.org/0009-0008-4997-95433932-5120LogvinLarisa A.ЛогвинЛариса Алексеевна
Russian Federation

Surgeon of Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine

врач-хирург хирургического отделения № 4 (неотложной хирургии) НИИ хирургии и неотложной медицины,

laralogvin@mail.ruhttps://orcid.org/0000-0001-6995-46013847-2304PopovDmitry N.ПоповДмитрий Николаевич
Russian Federation

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

канд. мед. наук, ассистент кафедры хирургии госпитальной № 2 с клиникой им. акад. Ф.Г. Углова, заведующий хирургическим отделением № 4 (неотложной хирургии) НИИ хирургии и неотложной медицины

dimtryp@gmail.comhttps://orcid.org/0000-0002-2830-16876680-4130KiselevaElena V.КиселеваЕлена Владимировна
Russian Federation

MD, PhD, Surgeon, Surgeon of Surgical Department No. 4 (emergency surgery) of the Research Institute of Surgery and Emergency Medicine

канд. мед. наук, врач-хирург хирургического отделения № 4 (неотложной хирургии) НИИ хирургии и неотложной медицины

cc221@yandex.ruhttps://orcid.org/0000-0001-7449-69087513-7648KorolkovAndrey Yu.КорольковАндрей Юрьевич
Russian Federation

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

д-р мед. наук, профессор, заведующий кафедрой хирургии госпитальной № 2 с клиникой им. акад. Ф. Г. Углова, руководитель отдела общей и неотложной хирургии НИИ хирургии и неотложной медицины

korolkov.a@mail.ruhttps://orcid.org/0000-0002-6380-137X3628-6860BagnenkoSergey F.БагненкоСергей Федорович
Russian Federation

MD, PhD, Dr. Sci. (Medicine), Professor, Academician of the Russian Academy of Sciences, Rector

д-р мед. наук, профессор, академик РАН, ректор

rector@spb-gmu.ruAcademician I.P. Pavlov First St. Petersburg State Medical UniversityПервый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова0106202516135453005202530052025Copyright ©; 2025, Eco-VectorCopyright ©; 2025, Эко-ВекторCopyright ©; 2025,2025Eco-VectorЭко-Векторhttps://journals.eco-vector.com/pediatr/article/view/681694

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.

Обоснование. На сегодняшний день, несмотря на развитие современных технологий, своевременная диагностика острого аппендицита у беременных по-прежнему остается актуальной задачей. Ранняя и правильная диагностика позволяет определить необходимую тактику и лечение, что сводит к минимуму возможные осложнения и отрицательные результаты оперативных вмешательств.

Цель — на основе анализа клинических данных определить подход к диагностике и лечению острого аппендицита у беременных во втором и третьем триместрах.

Материалы и методы. Произведен ретроспективный анализ историй болезни беременных пациенток (n=162), прооперированных с диагнозом «острый аппендицит» в период с 2010 по 2019 г. В исследовании учтены эпидемиологические, клинические, параклинические, оперативные и послеоперационные данные. Произведена их статистическая обработка.

Результаты. При проведении сравнительного анализа выделены наиболее значимые предикторы острого аппендицита у беременных: концентрация лейкоцитов в крови ≥12,5×109/л [относительный риск (ОР) (доверительный интервал, ДИ) 2,37 (1,47–3,80)], С-реактивного белка ≥21,0 мг/л [ОР (ДИ) 1,72 (1,36–2,17)], положительный симптом Кохера [ОР (ДИ) 2,01 (1,50–2,69)], а также процентное содержание гранулоцитов ≥78,0 [ОР (ДИ) 2,2 (1,29–3,77)] и наличие тошноты/рвоты [ОР (ДИ) 1,35 (1,03–1,76)]. На основании полученных данных однофакторного анализа разработана диаграмма дерева решений с определением риска вероятности развития острого аппендицита. Предложенная диаграмма дерева решений обладает хорошей чувствительностью (65,9%) и специфичностью (92,1%) при AuROC 0,86.

Заключение. Построенная диагностическая модель может использоваться в клинической практике для определения вероятности острого аппендицита у беременных во II–III триместрах беременности, а включение магнитно-резонансной томографии может существенно повысить качество диагностики, что требует дальнейших исследований в этом направлении.

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