What is peritonitis during pregnancy?
Peritonitis is inflammation of the peritoneum, the membrane that lines the pelvic and abdominal cavities and covers the internal organs. Sometimes the inflammation is a result of irritant chemicals or other non-infectious processes, but usually, it is due to a bacterial infection of the peritoneum. Such an infection can happen spontaneously in certain situations such as liver cirrhosis, but most of the time, bacterial peritonitis is secondary to infection or rupture of an abdominal or pelvic organ, or due to contents of the gastrointestinal (GI) tract being released. Consequently, peritonitis can develop as a component of pelvic inflammatory disease (PID), in which case, often just the pelvic region of the peritoneum is affected. It also can develop due to the rupture of a fallopian tube in an ectopic pregnancy located in the tube.
While PID and tubal ectopic pregnancy are the main settings relating to peritonitis in pregnancy, there also are several abdominal conditions that can cause peritonitis. These include perforation or rupture of an inflamed appendix, rupture of a stomach ulcer, rupture of a diverticulum (a pouch formed at a weak point in the gastrointestinal tract), pancreatitis (inflammation of the pancreas), Crohn’s disease, perforations of the gastrointestinal tract or gallbladder, and complications of surgery, or peritoneal dialysis (a procedure used in people with kidney failure to clean the blood). Of all these various situations, perforation or rupture of the appendix is particularly noteworthy, because appendicitis tends to strike young, healthy people, including women of reproductive age, and diagnosis of appendicitis can be tricky during pregnancy.
How common is peritonitis during pregnancy?
It is difficult to provide a particular number or percentage of pregnancies affected by peritonitis. This is because epidemiological studies relating peritonitis from any cause to pregnancy have not been published since the middle of the 20th century, as research has shifted to reporting on specific categories of peritonitis or unusual types of peritonitis, reporting on the acute abdomen (which may or may not include peritonitis) during pregnancy, and reporting on specific conditions, such as PID and appendicitis. Using PID as an example, based on data from the year 2018, the US Centers for Disease Control and Prevention reports approximately 2.5 million women, ages 1844, in the United States have been diagnosed with PID at some point in life.
Your risk of peritonitis depends greatly on whether or not you develop any of the conditions that can cause it. With certain emergency abdominal situations such as acute appendicitis, early diagnosis, and treatment make the possibility of escalation to peritonitis very unlikely. In the case of ectopic pregnancy, the main risk factor is a history of PID and/or infertility. As for PID, you are at elevated risk, if you have had multiple sex partners if your partner has multiple sex partners, if you are below age 25, if your age at your first intercourse was below 15 years if you have a history of sexually-transmitted disease (STD), or, if your ethnicity is not Caucasian.
How is peritonitis diagnosed?
Doctors will suspect peritonitis if you develop severe abdominal pain or tenderness that is dispersed rather than located at a single point. Typically, there is also a feeling of abdominal distention (a sense of fullness), plus there can be any of a variety of other symptoms, such as inability or difficulty passing stool or gas, nausea and vomiting, lack of appetite, fever, reduced output of urine, thirst, and fatigue. Suspicion will be particularly high, if you have been receiving peritoneal dialysis or have had abdominal surgery recently, or if you have suffered from acute appendicitis that was not assessed soon after the symptoms had developed, if you have suffered an abdominal injury, if you have suffered other abdominal conditions, such as pancreatitis or diverticulitis, or if you have cirrhosis due to alcohol abuse. For a definitive diagnosis, blood samples will be drawn for a complete blood count (CMC) to determine if your white blood cell count (WBC) is elevated high white blood cell count, plus bacteria may be cultured from your blood. Abdominal imaging will be performed, first using ultrasonography, since this does not expose the fetus to any ionizing radiation. Often, surgeons will also require abdominal X-ray scans, but the radiation dose from these is very small and not harmful. Whenever possible, doctors try to avoid computerized tomography (CT) scanning, because the radiation dose is much higher compared with simple X-rays, but CT is more revealing and may be needed in some instances. One important reason for the imaging is to reveal signs of perforations in the GI tract and organs and structures attached to it. If the cause of the peritonitis is acute appendicitis, imaging may also reveal a fecalith, a hardened piece of feces that blocks the entrance into the appendix. Imaging also can be performed with contrast material that you swallow. Doctors may also use a needle to extract a sample of fluid that has accumulated in the abdomen (peritoneal fluid) for analysis to see if the WBC is elevated and to culture to identify particular strains of bacteria. It is very important to diagnose and categorize peritonitis because some instances require surgery, while other cases do not. In the case of PID, for instance, the treatment consists of antibiotic medications.
Does peritonitis cause problems during pregnancy?
Peritonitis can lead to sepsis (infection throughout the body), failure of multiple organs, including kidney damage and liver damage that can lead to complications in the brain. These complications, in turn, can lead to shock and death. Fatal outcomes occur overall in 6 percent of peritonitis cases, but the mortality increases to 35 percent in cases when sepsis develops.
Does peritonitis cause problems for the baby?
Maternal peritonitis puts the life of the fetus at risk because the mothers life is at risk.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the peritonitis
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat peritonitis during pregnancy?
Antibiotic medications are given to combat bacterial peritonitis and to keep the infection from spreading. The duration and strength of the antibiotic treatment depend on the severity and type of peritonitis and on whether or not you are pregnant, but various antibiotic regimens are acceptable in pregnancy. These include moxifloxacin, metronidazole with a cephalosporin, and amoxicillin-clavulanate.
Who should NOT stop taking medication for peritonitis during pregnancy?
It is extremely important to complete your course of antibiot
ic treatment. Not doing so could have fatal consequences.
What should I know about choosing a medication for my peritonitis during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my peritonitis when I am breastfeeding?
There are antibiotic regimens that are effective against peritonitis and acceptable in nursing mothers, but your condition may not allow you to nurse the infant.
What alternative therapies besides medications can I use to treat my peritonitis during pregnancy?
Peritonitis requires antibiotic medications if it is bacterial peritonitis. Women with peritonitis also are given oxygen and other supportive measures, such as intravenous fluids and sometimes blood transfusions. Surgical may be needed to remove infected tissue, to treat appendicitis or other underlying causes of peritonitis, or to prevent the spread of the infection.
What can I do for myself and my baby when I have peritonitis during pregnancy?
Follow the instructions of your physicians. Peritonitis is potentially a life-threatening condition and falls into the framework of what is good for the mother is good for the baby.
Resources for peritonitis in pregnancy:
For more information about peritonitis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: