Acute appendicitis is the most common surgical emergency occurring during pregnancy. To determine possible methods for improving diagnostic and management accuracy, a retrospective review was conducted of 23 pregnant patients who underwent laparotomy with a preoperative diagnosis of acute appendicitis. Gestational stage at presentation included the first trimester in 2 patients, the second trimester in 6 patients and the third trimester in 15 patients. Eighteen patients (78.26%) had pathologically proven acute appendicitis. Perforation occurred in 2 patients. Postoperative fetal complications included one intrauterine death (4.3%) and three premature births. There was no maternal deaths and morbidity was limited to atelectasis and wound infection in 4 patients. Gestational physiologic changes make difficult the diagnosis of acute appendicitis. Prompt surgical intervention prevent maternal complications and foetal loss.