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Abdominal pain in pregnancy
Dr.Rupa Rajshekar MBBS, MD
Specialist in Obs & Gyne
Introduction
• Abdominal pain is a very common symptom in
pregnant women
• It is of varying degree, may be acute with
rapi...
• A 22 year old Para-1 with 6-8 weeks gestation
presents with abdominal pain
What are you thinking of???
History
• Localized one sided pain, no radiation,
spasmodic to start with – now constant
• Mild p/v bleeding
• Some chest ...
Think ectopic
• Vital signs
• B-HCG – quantitative
• Pelvic ultrasound
• Admission
Ectopic pregnancy
Pitfalls in diagnosis
• Wide variations in clinical presentation
• Pregnancy test can be negative
• Tran...
Treatment of ectopic pregnancy
• Medical with Methotrexate
• Surgical – Laparotomy/Laparoscopy
» salphingostomy / salphing...
Is it Ovarian?
• Corpus luteum cysts:
– Mild aching pain
– Usually asymptomatic
– Maternal pulse in not raised
– Hemorrhag...
Adnexal torsion
• More common in pregnancy (28%)
• Pain is sudden in onset in lateral lower quadrant
• Fever, leucocytosis...
First trimester pain
• Abortion
• Pregnancy in rudimentary horn
• Acute salpingitis
• Acute retention of urine
• Hydatidif...
A 22 yr old para 1 with 6-8 weeks
amenorrhea presents with
abdominal pain
• The history changes:
– Crampy lower abdominal ...
Diagnosis - ? Miscarriage
• Assess hemodynamic stability
• Arrange pelvic ultrasound
• Management depends on ultrasonograp...
Some USS findings
• An intrauterine gestational sac seen 25x30
mm in diameters. No fetus visible
• An IU gestational sac s...
The management of miscarriage
• Conservative
• Reassurance and TLC
• No role of bed rest
• ERPOC
Miscarriage
• Always confirm a possible complete
miscarriage by serial BHCGs
• This is specially true if there has been no...
First trimester pain
• Pregnancy in rudimentary horn
• Pain resemble that of ectopic & usually the
condition discovered du...
First trimester pain
• Acute Salpingitis:
• May develop up to 10 wks after conception,
due to gonococcal infection or infe...
First trimester pain
• Acute retention of urine
• Due to enlargement of fibroid in response to
pregnancy
• Severe lower ab...
First trimester pain
• Hydatidiform mole
• Pain in lower abdomen due to
– Overdistention of uterus
– Concealed haemorrhage...
Mid trimester pain
• Red degeneration of fibromyoma
• Stretching of round ligament
• Acute polyhydromnios
• Rupture of rud...
Mid trimester pain
• Red degeneration of fibromyoma
• Causes mild to severe pain. Tenderness
present over fibroid
• USS de...
Mid trimester pain
• Stretching of round ligament
• 10-30% of pregnancies
• More in multipara
• Cramp like or stabbing con...
Mid trimester pain
• Acute polyhydrominos
• Pain due to over distention
• Diagnosed clinically & by USS
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
Rupa  abdominal pain in pregnancy
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Rupa abdominal pain in pregnancy

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Abdominal pain in pregnancy is a very common problem encountered in day to day practice. Although is can be benign at times great care should be exercised to dismiss as nothing significant.

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Rupa abdominal pain in pregnancy

  1. 1. Abdominal pain in pregnancy Dr.Rupa Rajshekar MBBS, MD Specialist in Obs & Gyne
  2. 2. Introduction • Abdominal pain is a very common symptom in pregnant women • It is of varying degree, may be acute with rapid onset or chronic that recurs or persists for long time • It is convenient to divide the cause of pain due to pregnancy into those most commonly encountered in each of the three trimesters
  3. 3. • A 22 year old Para-1 with 6-8 weeks gestation presents with abdominal pain What are you thinking of???
  4. 4. History • Localized one sided pain, no radiation, spasmodic to start with – now constant • Mild p/v bleeding • Some chest pain & shoulder tip pain • Has been feeling faint • Pregnancy test positive
  5. 5. Think ectopic • Vital signs • B-HCG – quantitative • Pelvic ultrasound • Admission
  6. 6. Ectopic pregnancy Pitfalls in diagnosis • Wide variations in clinical presentation • Pregnancy test can be negative • Trans vaginal ultrasound even in best hands is only 50% accurate in early ectopics • B-HCG can double in very early ectopics
  7. 7. Treatment of ectopic pregnancy • Medical with Methotrexate • Surgical – Laparotomy/Laparoscopy » salphingostomy / salphingectomy
  8. 8. Is it Ovarian? • Corpus luteum cysts: – Mild aching pain – Usually asymptomatic – Maternal pulse in not raised – Hemorrhage inside cyst can cause severe pain
  9. 9. Adnexal torsion • More common in pregnancy (28%) • Pain is sudden in onset in lateral lower quadrant • Fever, leucocytosis, nausea, vomiting • USS – shows cyst with no flow on color mapping • At times difficult to differentiate from ectopics and appendicitis • Miscarriage & preterm are common consequences • Surgery should not be delayed
  10. 10. First trimester pain • Abortion • Pregnancy in rudimentary horn • Acute salpingitis • Acute retention of urine • Hydatidiform mole
  11. 11. A 22 yr old para 1 with 6-8 weeks amenorrhea presents with abdominal pain • The history changes: – Crampy lower abdominal pain – Heavy bleeding p/v – Speculum examination • Cx os closed • Cx os open
  12. 12. Diagnosis - ? Miscarriage • Assess hemodynamic stability • Arrange pelvic ultrasound • Management depends on ultrasonographic findings • No role of B-HCG • Blood group, Rhesus and anti D if needed
  13. 13. Some USS findings • An intrauterine gestational sac seen 25x30 mm in diameters. No fetus visible • An IU gestational sac seen 20x20mm in diameter, Fetal pole seen 6 mm CRL. No FH • An IU gestational sac seen 35 x35 mm in diameters low down in the cavity. Fetal pole seen. FH seen but appears slow
  14. 14. The management of miscarriage • Conservative • Reassurance and TLC • No role of bed rest • ERPOC
  15. 15. Miscarriage • Always confirm a possible complete miscarriage by serial BHCGs • This is specially true if there has been no scans to prove an intrauterine gestational sac • Pitfall: You might miss an ectopic
  16. 16. First trimester pain • Pregnancy in rudimentary horn • Pain resemble that of ectopic & usually the condition discovered during laparotomy • If rupture occurs it usually in the mid- trimester & of sudden onset with collapse
  17. 17. First trimester pain • Acute Salpingitis: • May develop up to 10 wks after conception, due to gonococcal infection or infection due to attempted abortion • Pain felt in both iliac fossae & is continous • Associated tenderness, tachycardia & elevated temperature, culture of discharge may reveal pathogen
  18. 18. First trimester pain • Acute retention of urine • Due to enlargement of fibroid in response to pregnancy • Severe lower abdominal pain, large tender bladder which may be mistaken for ovarian cyst • Catheterisation causes immediate pain relief
  19. 19. First trimester pain • Hydatidiform mole • Pain in lower abdomen due to – Overdistention of uterus – Concealed haemorrhage – Perforation – Infection
  20. 20. Mid trimester pain • Red degeneration of fibromyoma • Stretching of round ligament • Acute polyhydromnios • Rupture of rudimentary horn containing pregnancy • Acute retention of urine due to incarcerated RVF gravid uterus
  21. 21. Mid trimester pain • Red degeneration of fibromyoma • Causes mild to severe pain. Tenderness present over fibroid • USS detects fibroid • Conservative treatment with analgesics
  22. 22. Mid trimester pain • Stretching of round ligament • 10-30% of pregnancies • More in multipara • Cramp like or stabbing continuous pain, some tenderness in the groin • Reassurance & mild analgesics required
  23. 23. Mid trimester pain • Acute polyhydrominos • Pain due to over distention • Diagnosed clinically & by USS

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