Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy and remains a significant cause of maternal and fetal morbidity when diagnosis or treatment is delayed. The diagnosis of appendicitis in pregnant patients is particularly challenging because physiological, anatomical, and biochemical changes of pregnancy may obscure classical clinical manifestations. Delayed diagnosis increases the risk of appendiceal perforation, which is associated with preterm labor, fetal loss, maternal sepsis, and adverse neonatal outcomes. Imaging modalities, particularly ultrasonography and magnetic resonance imaging (MRI), have become essential components of the diagnostic pathway. Surgical intervention continues to represent the cornerstone of treatment. Recent evidence and international guidelines support laparoscopic appendectomy as the preferred surgical approach in most pregnant patients because of its favorable maternal outcomes, shorter hospital stay, and lower wound complication rates. Nevertheless, open appendectomy remains appropriate in selected clinical situations. Emerging literature on non-operative management using antibiotics has generated interest; however, current evidence suggests that surgery remains the standard of care due to concerns regarding treatment failure, recurrence, and maternal-fetal complications. Multidisciplinary collaboration among surgeons, obstetricians, anesthesiologists, radiologists, and neonatologists is crucial to optimizing outcomes. This review examines the diagnostic and current recommendations regarding the management of acute appendicitis in pregnancy.