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Pregnant patient at risk for unnecessary appendectomy
Pregnant women who come to the ED with abdominal pain often are misdiagnosed and undergo unnecessary appendectomies, says a new study.1
Researchers looked at 94,789 women who underwent open or laparoscopic appendectomy, and 3,133 of them were pregnant. The rate of negative appendectomy was significantly higher in pregnant women (23% vs. 18%) than in nonpregnant women.
"I think the most important message for ED nurses is that abdominal pain in the pregnant patient can be difficult to diagnose and may include both surgical and nonsurgical causes," says Marcia McGory, MD, the study's author and research fellow at the Center for Surgical Outcomes and Quality at the University of California — Los Angeles Medical Center
Although negative appendectomy in other patient populations generally does not have any unforeseen consequences, unnecessary surgery should be minimized in the pregnant patient due to risk to the fetus, she explains. The study's results suggest that improved diagnostic accuracy of appendicitis in pregnant women may minimize risk of fetal loss or early delivery, says McGory. "ED nurses can assist with patient advocacy by encouraging pregnant women to pursue additional imaging prior to making the decision to undergo surgery to remove the appendix," she says.
Assessing pregnant patients
At Virginia Commonwealth University Medical Center in Richmond, ED nurses ask patients the following questions at triage for pregnant patients with abdominal pain, says Steve Rasmussen, RN, CEN, clinical coordinator for the ED: