Appendicitis while expecting
Erin H. Burnett, M.D., FACOG
UF Health Jacksonville successfully treats woman 30 weeks pregnant with appendicitis.
Jessica and Wesley Hurlock were counting down the weeks before they brought their first child into the world. The Kingsland, Georgia, couple had been waiting to meet little Emma since last October, when they first learned they were expecting.
“I will never forget that morning,” Wesley Hurlock, 31, said. “We were getting ready for work, when she came around the corner in tears with the news.”
They did what they could to prepare. They read books, talked to friends who had children and attended regular prenatal appointments. It’s how Jessica knew the sharp pains she felt at the grocery store on March 26 were not normal.
“The pain felt like I was going into labor,” Jessica Hurlock, 32, said. “It was a consistent, stabbing pain on my right side.”
They went to a local hospital where she was diagnosed with a urinary tract infection and given antibiotics. A few hours later, the pain worsened, sending the couple across the state line to a Florida emergency room.
“I couldn’t get in and out of bed without screaming,” Jessica said. “I knew this had nothing to do with the pregnancy.”
“It was nerve-wracking. I was scared out of my mind,” Wesley said. “I was trying really hard not to freak out because it wouldn’t do anybody any good.”
Providers there suspected Jessica had appendicitis, inflammation of the appendix, but the Nassau County hospital did not have a neonatal intensive care unit. She was transported to UF Health Jacksonville by ambulance.
“She was 30 weeks pregnant, so I had her immediately placed on the monitor to make sure she was not contracting,” said Jared Dowdy, MD, University of Florida OB-GYN resident physician at UF Health Jacksonville. “At that point, I was concerned about her appendix possibly bursting.”
The appendix is a small pouch that usually protrudes from the large intestine into the lower right corner of the abdomen. According to the American Journal of Obstetrics and Gynecology, appendicitis is the most common, non-obstetric emergency that may require surgery during pregnancy. It is seen in approximately one out of 1,500 pregnancies and commonly happens during the second or third trimester.
“This mom was very sick. She was possibly headed to the operating room, which increases her risk of preterm labor,” said Erin Burnett, MD, the attending maternal and fetal medicine physician. “We started her on betamethasone, which helps lung maturity. We also gave her magnesium, which provides neuroprotection for her baby to decrease the risk of cerebral palsy.”
After consulting with surgeons, Jessica was placed on observation and had an abdominal exam every two hours to ensure her condition didn’t change. She was watched closely in the Labor and Delivery unit where she remained for about a week.
“This family was very scared,” Dowdy said. “They needed someone who could provide as clear a picture as possible and at a level they could understand. I spent a lot of time communicating our expectations and plan of care with them.”
All Jessica could do was rest and wait. Wesley remained by her side. The couple had relatives in Jacksonville who provided them with fresh clothes and welcomed breaks during the process. After being on antibiotics for four days, her symptoms were nearly gone.
“Clinically, she improved dramatically, Burnett said. “Her pain got better. Her fevers went away. Her white cell count went down. She improved so much, they planned to do the appendectomy after delivery.”
Jessica was discharged March 31. Less than a month later on April 27, Emma was born weighing 6 pounds, 13 ounces and measuring 19 inches long. Both Jessica and Emma were healthy. The new parents now have their hands full with their newborn. Their days are filled with diaper changes, feedings and playtime. Though it’s been an adjustment, they appreciate every moment especially after the emergency.
“Dr. Dowdy was amazing. He remained calm which kept us as calm as we could be in the situation,” Wesley said.
“The nurse in triage was also amazing,” Jessica said. “After I was transferred into the Labor and Delivery unit, she came and visited me.”
“Appendicitis can very easily become fatal if it is not caught in time,” Dowdy said. “Thankfully, we are accustomed to taking care of very sick patients and are equipped to handle it here. We have experts available 24 hours a day, seven days a week.”
Jessica, Wesley and Emma are now making new memories together, and they are grateful for the physicians and nurses who helped make their happy family of three possible.
Erin H. Burnett, M.D., FACOG