Diagnostic reserves for detalization of acute appendicitis in pregnant women

Abstract

The aim of the work: to establish additional diagnostic criteria for the diagnosis of acute appendicitis in pregnant women to optimize
the treatment of this pathology.
Materials and Methods. 864 pregnant women were hospitalized in the Surgical Department of the City Clinical Hospital No.1, No.3 in
2004–2012, who were divided into the research (n = 473) and control (n = 391) groups. The most frequent acute appendix occurred – in
258 (29.8 %) of all cases of hospitalization. In the course of the examination, along with the generally accepted studies, hematological,
cytological and immunological parameters were studied in pregnant women with a diagnosis of acute appendicitis. To evaluate the
pathogenetic mechanisms of formation of inflammatory response in pregnant women of the study group, as well as for the possibility
of differential diagnosis and early prediction of complications, we conducted research on the activity of the functioning of nonspecific
resistance and immunological reactivity: NST test, determination of Ig M, Ig G, Ig levels E, Ig A, PPK (procalcitonin), Il β-1, TNF
(tumor necrosis factor).
Results and Discussion. In conducting biochemical studies to determine the typical additional markers of acute appendicitis in pregnant
women, we established that the signs of development of endotoxicosis associated with the accumulation of toxins of microbial
origin (TZN), decompensation of functional activity of phagocytic cells – neutrophil granulocytes (stimulation index) and toxins’
binding and biosensing ability of the liver to the AST/ALT ratio, the presence of cryoglobulins. It was found that in the patients of the
second clinical group, the data trends were more pronounced. It has been determined that patients of both clinical groups exhibit signs
of an inflammatory response such as increasing the concentration of major inflammatory mediators - IL-1 and FNP relative to the values
of healthy individuals. It was found that in the second main clinical group, the changes were more pronounced, which indicates a
significant activity of inflammatory reactions. In doing so, compensating the effect of anti-inflammatory mediators was reduced, which
may be the cause of decompression reaction and the cause of the risk of developing a systemic inflammatory response.