Tohighlight the problemsrelated to acute appendicitis in pregnancy,difficulty in diagnosis, risk of appendiceal perforation and to lay down the principles of management. All pregnant patients with diagnosis of acute appendicitis from January 1997 to December 2001 at Shifa International Hospital, Islamabad., Pakistan were reviewed retrospectively, there were 3812 deliveries during this period. Eleven had acute appendicitis. The age of these patients ranged from 17 to 44 years. Most of the 11 affected patients were in third trimester of pregnancy (n=07), followed by second and first trimester (n-02 each). Nausea and vomiting were the most common complaints experienced (81%) patients. All underwent laparotomy, with ten (91%) positive and one (9%) negative appendix. Perforation was encountered in two patients (18%). No maternal or fetal loss was noted. Nausea, vomiting and abdominal pain were commonest presenting symptoms in our patients. Two had perforated appendix. Early surgical intervention resulted in safe maternal and fetal outcome.