Acute appendicitis in pregnancy is the most common non-obstetric complication warranting emergency laparotomy. A retrospective study of 52 pregnant patients who underwent laparotomy for suspected acute appendicitis between June 1982 and June 1995 revealed a histopathological diagnosis in 29 (56%) patients. The hospital incidence for acute appendicitis in pregnancy was 0.09% (1 in 1102 deliveries). There were 10 (19%) patients who presented in the first trimester, 31 (60%) second trimester, 8 (15%) third trimester and 3 (6%) patients in the puerperium. Abdominal pain in the right lower quadrant was the most common presenting symptom. Abdominal tenderness and rebound tenderness were the most common physical signs, although the latter was less marked in late pregnancy. Preoperative laboratory investigations were equivocal in reaching a decision for surgical intervention. Laparotomy was performed within 24 hours of onset of symptoms in 67% of patients. Perforation of the appendix was found in 4 (14%) patients, all of whom had symptoms exceeding 24 hours. Wound infection occurred in 4 (9.6%) patients, 3 of whom had a perforated appendix. There were 2 (9%) fetal losses among the patients with negative laparotomies. Five (17%) other fetuses were lost in the group with diseased appendix, three of these were in patients with perforated appendix. There was no maternal death in the study.