Peritonitis in Pregnancy

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Peritonitis, one of the causes of so-called acute abdomen, is a condition in which the inner lining of the abdominal cavity, called the peritoneum, becomes inflamed. It’s usually caused by an infection of some kind, most often bacterial, but fungal and viral infections may also be to blame. If you are concerned that you might have peritonitis, read on to learn more about the symptoms, causes, and treatment options for this disease.

Recognize the symptoms

The symptoms of peritonitis (listed below) are good to know, but if you’re pregnant, you may notice something unfortunate: some of these symptoms are actually par for the course during pregnancy. Except in the case of fever or not making urine—both of which are dangerous and should be addressed immediately with a health professional—it’s tough to know whether you’re experiencing the normal discomforts of pregnancy or whether there might be something more serious going on.

One way is to differentiate peritonitis symptoms from normal pregnancy complaints is to tune in to both the onset of the symptom and its severity. For most people, pregnancy discomforts come and go. While they can be overwhelming and really uncomfortable, they’re not often excruciatingly painful. If you experience any of the listed symptoms in a way that comes on suddenly or feels out of the norm for you and your pregnancy, please call your doctor or midwife. Perhaps nothing is wrong and you get reassurance, but maybe you can get checked out and catch a problem before it becomes more serious.

Look out for the following symptoms:

Peritonitis can be caused by bacterial, fungal, or viral infections, or occasionally by a reaction to chemicals in the environment. Another common causes of peritonitis is a perforated appendix following untreated acute appendicitis.

Know the causes

As discussed briefly above, peritonitis can be caused by bacterial, fungal, or viral infections, or occasionally by a reaction to chemicals in the environment. Another common causes of peritonitis is a perforated appendix following untreated acute appendicitis—an inflammation of the appendix that can present differently in pregnant women. You’re used to hearing about appendicitis manifesting as pain on the lower right side of the abdomen, but the truth is that as your baby and uterus grow and push other things in your abdomen out of the way, that pain might feel very different. Therefore, any severe abdominal pain should be discussed with your care provider as soon as possible, so that it can be addressed before it gets more serious. The chances of developing peritonitis go up if your appendix bursts. You can also learn more about appendicitis during pregnancy in this blog post from The Pulse.

How is peritonitis treated?

If you are diagnosed with peritonitis, your care providers will likely try to determine the cause. If it’s appendicitis, you will probably have surgery. If not, your doctors may do a biopsy of your peritoneum in order to see whether your peritonitis is caused by a bacterium, fungus, or virus. If it’s caused by a fungus or a bacterium, you’ll likely receive antifungals or antibiotics. It’s likely also that you’d stay in the hospital while you are receiving treatment and until your symptoms improve.

Case Studies

If you’ve been diagnosed with peritonitis, try not to worry. In the case studies that are available to read online, pregnant women who get treatment as soon as possible tend to continue with otherwise healthy pregnancies and have healthy babies.

For instance, in a study published in Archives in Biomedical Engineering & Biotechnology in January 2019, a 40-year-old woman who was 23 weeks pregnant developed peritonitis caused by acute appendicitis. After receiving surgery and antibiotics, she recovered and returned home, eventually having a healthy baby girl by cesarean section at 39 weeks of pregnancy.

In another example, published in the Journal of Medical Case Reports in January 2014, a 31-year-old woman 22 weeks along in her pregnancy had abdominal pain in the six months leading up to her diagnosis. She also received antibiotics specific to the bacterial strain causing her peritonitis, which reduced her symptoms, and later gave birth to a healthy baby boy. In this example, the patient initially attributed her abdominal discomfort to pregnancy, until it became so severe that it no longer seemed consistent with a normal, healthy pregnancy.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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