The purpose of the study was to evaluate the diagnostic effectiveness of clinical symptoms of acute appendicitis in non-pregnant and pregnant women at different stages of gestation. Materials and methods. 124 patients with a diagnosis of acute appendicitis were examined. All patients were divided into 2 groups. The first group consisted of pregnant women of different gestational ages, the second group – comparison group consisted of non-pregnant women. The informativeness of such symptoms as Kocher-Volkovich, Rovzing, Bartomier-Michelson, Sitkovsky, Gabay, Brando, Michelson, Ivanov has been studied. Results and discussion. Pain syndrome was noted in all examined women of groups 1 and 2. The localization of pain in women of group 1 was varied and depended on the term of pregnancy. Most often the pain was observed in the epigastrium, followed by dislocation in the right iliac region. There was a significant decrease in the manifestations of such migration with each subsequent trimester. From the second half of pregnancy, pain in acute appendicitis was more often localized in the upper abdomen, namely in the right mesogastric region. There was a tendency to increase the frequency of pain in the right hypochondrium with increasing gestational age. In a small number of women, the pain was not clearly localized, was less pronounced. Pain in the lower abdomen, namely in the pubic and right groin areas was observed in isolated cases and only in early pregnancy. In women of group 2 in most cases the localization of pain was observed in the epigastrium with subsequent migration to the right iliac region. All symptoms had different qualitative characteristics. For non-pregnant women, the most informative were the symptoms of Kocher-Volkovich, Rovzing, in particular, their characteristics such as accuracy, sensitivity and efficiency, the level of which significantly exceeded the corresponding values in pregnant women. The diagnostic efficacy of symptoms such as Bartomier-Michelson and Sitkovsky was significantly higher in the group of pregnant women. The frequency of symptoms of acute appendicitis, which are characteristic of the pregnancy of Brando, Michelson and Ivanov, was maximal in the second trimester. Conclusion. Thus, the pain was accompanied by acute appendicitis in all women of both groups. The location of pain in pregnant women varied depending on the gestational age. Significant are specific clinical symptoms: Bartomier-Michelson, Sitkovsky, Brando, Michelson, Ivanov in the correct diagnosis of acute appendicitis in pregnant women. They should be considered as characteristic symptoms of acute appendicitis during pregnancy

18 1. Вступ Гострий апендицит-найчастіша причина невідкладних хірургічних операцій під час вагітності. Частота його виникнення коливається від 1:700 до 1:3000 вагітних [1, 2]. Апендектомія становить 25 % від всіх абдомінальних втручань серед неакушерских операцій в період вагітності. Близько 50 % випадків припадає на II триместр, ще 50 %-на I і III триместри вагітності [3, 4]. Захворюваність на гострий апендицит у вагітних в 2 рази вища, ніж у невагітних жінок. Ця патологія, зважаючи на високий рівень захворюваності (0,03-5,2 %) і стабільний рівень летальності, без тенденції до зниження (0,1-0,5 %), до цього часу залишається актуальною проблемою [5]. Більше ніж в 50 % спостерігаються діагностичні помилки, які призводять до непрофільної госпиталізації хворих і, відповідно, до затримки оперативного втручання [6]. Незважаючи на досягнення медичних технологій, доопераційна діагностика досі викликає труднощі. Одним з найбільш інформативних методів, який дозволяє швидко поставити діагноз гострого апендициту в Пуляєва Інна Сергіївна, кандидат медичних наук, старший науковий співробітник, відділення гострих захворювань судин, Державна Установа "Інститут загальної та невідкладної хірургії ім. В. Т. Зайцева Національної академії медичних наук України", в'їзд Балакірєва,

The purpose of the study is to assess the efficiency results of treatment of acute appendicitis in pregnant women by using laparoscopy at different periods of gestation on the basis of studying the effect of increased intra-abdominal pressure due to carbon dioxide pneumoperitoneum on the course of pregnancy, the state of the uterus and fetus, as well as improving the technique of performing the operation. Materials and methods. 73 pregnant women with acute appendicitis were examined. The average age of the surveyed was 25.9±0.7 years, ranged from 17 to 42 years. The gestation period ranged from 4-5 to 37-39 weeks. There were 26 (35.6%) pregnant women in the first trimester, 32 (43.8%) – in the second trimester, and 15 (20.5%) – in the third trimester. The intervention was performed using the Olympus OTV-SC endoscopic complex. Pneumoperitoneum with CO2 was created about 10-12 mm Hg. In all women, the parameters of body temperature and blood pressure were studied, and the postoperative restoration of the motor-evacuation function of the gastrointestinal tract was assessed. Laboratory research included the study of individual indicators of the leukocyte formula, changes in the hemostasis system and microbial contamination of tissues of trocar wounds. The results of the effect of increased intra-abdominal pressure during laparoscopy on the state of the fetus and uterus in the early postoperative period were assessed using the BMT-9141 (Germany) and FM-7 (England) fetal monitor in women with a gestational age of 32 - 39 weeks. Results and discussion. The study showed that laparoscopy is possible with good results in the treatment of acute appendicitis in pregnant women in the first, second and third trimesters but with few exceptions. The technical features of performing laparoscopy in pregnant women are associated with the increased size of the uterus during the development of pregnancy. When substantiating therapeutic measures for endoscopic interventions based on the study and assessment of signs of systemic inflammatory response syndrome like temperature reaction, individual indicators of leukocyte count, peripheral hemodynamics, as well as restoration of dysfunctions of the gastrointestinal tract, the revealed advantages of laparoscopic appendectomy. Removal of the appendix from the abdominal cavity in plastic containers reduced microbial contamination of wounds, leading to a decrease in the number of postoperative complications. Conclusion. Laparoscopic interventions are effective in acute appendicitis in pregnant women. They provide a mild intoxication syndrome, rapid physical rehabilitation of patients. Their advantages are the reduction of manifestations of uterus and fetal disorders, rapid postoperative recovery of gastrointestinal tract functions

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