Appendicitis continues to be the most common nonobstetric surgical diagnosis in pregnancy. Historically, this diagnosis has been associated with an increased risk of fetal loss as well as maternal morbidity. The physiologic and anatomic changes in pregnancy have been thought to obscure and thus delay the diagnosis of acute appendicitis, contributing to its increased risk in pregnancy. Such increased risks have been well reported in literature. To further evaluate the overall incidence, to determine the factors contributing to delay in diagnosis, and to assess overall outcomes in appendicitis in pregnancy, we performed a retrospective contemporary evaluation of pregnant patients with the diagnosis of acute appendicitis during the period 1991-1998. Twenty-two patients had the combined admitting diagnoses of pregnancy and acute appendicitis among 44,845 deliveries for the same time period (incidence, 0.05%). Gestational stage at diagnosis was the first trimester in 5 patients (22%), second trimester in 6 patients (27%), and third trimester in 11 patients (50%). Nineteen patients (86%) had pathologically proven acute appendicitis. Sixteen patients (73%) presented with less than 24 hours of abdominal symptoms. Seventeen patients (77%) presented with findings of rebound and guarding on initial physical examination. Fifteen patients (68%) were taken to the operating room within 24 hours of presentation. Of these, 10 patients (68%) had acute perforated appendicitis. Overall, there were 12 cases of perforated appendicitis (55%), which is an incidence higher than what has been reported in literature. There were no instances of fetal mortality. Preterm labor occurred in 5 patients, all in their third trimester with perforated appendicitis. Our study found that our population paralleled the incidence of gestational appendicitis of 0.05-0.07 per cent; physical examination on presentation was the most reliable diagnostic tool for appendicitis; and there is a higher incidence of perforation with increased gestational age, which does not result in increased fetal mortality.