BACKGROUND: Acute appendicitis in pregnancy is the most common cause of emergency surgery, except for obstetric pathologies. Physiological changes in pregnancy reduce the sensitivity of acute appendicitis symptoms and signs. This study aimed to compare the effectiveness of the Alvarado, AIR (Appendicitis Inflammatory Response), RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis), and Tzanakis scoring systems in pregnant patients and to evaluate the results of surgical techniques.
METHODS: 39 pregnant patients who underwent surgery with the diagnosis of acute appendicitis between January 2017 and January 2025 were retrospectively examined. Demographic data, gestational weeks, symptoms and findings, laboratory parameters (WBC, CRP), ultrasonography findings, surgical techniques applied (open/laparoscopic), histopathological results, and maternal and fetal complications were recorded. The Alvarado, AIR, RIPASA, and Tzanakis scores were calculated, and the patients were divided into risk groups according to the cut-off values determined in the literature and compared with the histopathological diagnosis.
RESULTS: The mean age of the patients was 26.0 ± 5.3 years, the mean gestational week was 19.6 ± 7.9, and 53.8% were in the 2nd trimester. Open appendectomy was performed in 61.5% of the patients, and laparoscopic appendectomy was performed in 38.5% of the patients. 66.7% of the patients were in the high-risk group according to the Alvarado score, 69.2% according to the AIR score, and 79.5% according to the RIPASA and Tzanakis scores. Histopathologically, 66.7% of the cases were evaluated as acute appendicitis, 15.4% as perforated appendicitis, and 17.9% as normal appendix. WBC and CRP levels were found to be significantly higher in patients diagnosed with acute appendicitis (p<0.05). The sensitivity and specificity ratios of the scoring systems were highest in the RIPASA (93.7% and 85.7%) and Tzanakis (90.6% and 71.4%) scores. Laparoscopic surgery allowed shorter hospital stay compared to open surgery (p<0.001) and had a similar safety profile in terms of maternal/fetal complications.
CONCLUSION: Clinical scoring systems are an effective and reliable tool in the diagnosis of acute appendicitis in pregnant women, and the RIPASA score shows the highest diagnostic performance. Elevated CRP and leukocytosis may contribute to the diagnosis. Laparoscopic appendectomy is a safe option with a short hospital stay compared to open surgery. These findings support that both clinical scoring systems and laparoscopic surgery can be used safely in pregnant patients.

Keywords: Pregnancy, acute appendicitis, RIPASA

Gebelikte akut apandisit taný yöntemlerinin kýsýtlýlýklarý klinik skorlama sistemleri ile aþýlabilir mi?

AMAÇ: Gebelikte akut apandisit, obstetrik patolojiler dýþýnda en sýk acil cerrahi nedenidir. Gebelikteki fizyolojik deðiþimler akut apandisit semptom ve bulgularýnýn duyarlýlýðýný azaltmaktadýr. Bu çalýþmanýn amacý gebe hastalarda Alvarado, AIR (Appendicitis Inflammatory Response), RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) ve Tzanakis skorlama sistemlerinin etkinliðini karþýlaþtýrmak ve cerrahi tekniklerin sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2017 – Ocak 2025 tarihleri arasýnda, akut apandisit tanýsý ile ameliyat edilen 39 gebe hasta retrospektif olarak incelendi. Hastalarýn demografik verileri, gestasyonel haftalarý, semptom ve bulgularý, laboratuvar parametreleri (WBC, CRP), ultrasonografi bulgularý, uygulanan cerrahi teknikler (açýk/laparoskopik), histopatolojik sonuçlar, maternal ve fetal komplikasyonlar kaydedildi. Alvarado, AIR, RIPASA ve Tzanakis skorlarý hesaplanarak hastalar literatürde belirlenen cut-off deðerlerine göre risk gruplarýna ayrýldý ve histopatolojik taný ile karþýlaþtýrýldý.
BULGULAR: Hastalarýn yaþ ortalamasý 26.0 ± 5.3 yýl, gestasyonel haftalarý 19.6 ± 7,9 idi; %53.8’i II. trimesterdeydi. Hastalarýn %61.5’ine açýk apendektomi, %38.5’ine laparoskopik apendektomi yapýldý. Hastalarýn Alvarado skoruna göre %66.7’si, AIR skoruna göre %69.2’si, RIPASA ve Tzanakis skorlarýna göre %79.5’i yüksek risk grubundaydý. Histopatolojik olarak olgularýn %66.7’si akut apandisit, %15.4’ü perfore apandisit, %17.9’u normal apendiks olarak deðerlendirildi. Akut apandisit tanýlý hastalarda WBC ve CRP düzeyleri anlamlý þekilde yüksek bulundu (p<0.05). Skorlama sistemlerinin duyarlýlýk ve özgüllük oranlarý RIPASA (%93.7 ve %85.7) ve Tzanakis (%90.6 ve %71.4) skorlarýnda en yüksek olarak izlendi. Laparoskopik cerrahi, açýk cerrahiye kýyasla daha kýsa hastanede kalýþ süresi saðladý (p<0.001) ve maternal/fetal komplikasyonlar açýsýndan benzer güvenlik profiline sahipti.
TARTIÞMA: Gebelerde akut apandisit tanýsýnda klinik skorlama sistemleri etkin ve güvenilir bir araçtýr; RIPASA skoru en yüksek tanýsal performansý göstermektedir. CRP yüksekliði ve lökositoz, tanýya katký saðlayabilir. Laparoskopik apendektomi, açýk cerrahiye kýyasla kýsa hastanede kalýþ süresi ile güvenli bir seçenektir. Bu bulgular, gebe hastalarda hem klinik skorlama sistemlerinin hem de laparoskopik cerrahinin güvenle kullanýlabileceðini desteklemektedir.

Anahtar Kelimeler: Gebelik, Akut apandisit, RIPASA