lecture for medical students

1. Dr. TARIG MAHMOUD
MD SUDAN
HAIL UNIVERSITY KSA

2. Abdominal pain is one of the most common
disorders of pregnancy; the problem is in
distinguishing pathological from ‘physiological’
pains.
Urgent hospital referral is often required,
unless a benign cause can be established
with certainty in the absence of maternal or
foetal distress.

3. Early pregnancy (< 24 weeks)
1) Ligament stretching
2) Miscarriage
3) Vesicular mole: when expulsion starts.
4) Ectopic pregnancy
5) Acute urinary retention due to retroverted
gravid uterus.

4. Later pregnancy (> 24 weeks)
1) Braxton-Hicks Contraction.
2) Round Ligament Pain.
3) Pressure symptoms.
4) Placental abruption .
5) Pre-eclampsia .
6) Spontaneous rupture of the liver.
7) Acute Polyhydramnios.
8) labour.
9) uterine rupture.
10)Chorioamnioitis.

5. Uterine/ovarian causes
 Torsion or degeneration of fibroid.
 Ovarian cyst accident:
1) Torsion
2) Haemorrhage
3) Rupture

6. Urinary tract disorders
 Urinary tract infection (acute cystitis and
acute pyelonephritis)
 Renal colic.

7. Gastrointestinal disorders
 Gastric/duodenal ulcer
 Acute appendicitis
 Acute pancreatitis
 Acute gastroenteritis
 Intestinal obstruction or perforation

8. Medical causes
 Sickle cell disease (abdominal crisis)
 Diabetic ketoacidosis
 Acute intermittent porphyria
 Pneumonia (especially lower lobe)
 Pulmonary embolus
 Malaria

9.  History is MOST essential to diagnosis:
 Pain
-Location
-Character
-Radiation
-Aggravating/Relieving Factors
 Associate symptoms :
-vaginal bleeding.
-bowel and urinary symptoms.
-pre-eclampsia symptoms (headache, visual
change, nausea).

10.  Foetal movements.
 Obstetric History
-LMP
-confirm use of any contraception (coil and
progestogen-only pill (POP) increase ectopic
risk).

11.  General examination
– well/ill, signs of sepsis, shock or
haemorrhage, blood pressure and pulse
 Assess the pregnancy and uterus:
- Palpate uterus for fundal height,
contractions or hard uterus,
polyhydramnios, fetal position and
presentation.
- Assess fetal wellbeing - movements or
heartbeat (auscultate, Doppler scan or
CTG).

12.  Abdominal examination
◦ To distinguish extra-uterine from uterine
tenderness, lie the patient on her side,
thus displacing the uterus.
◦ Peritoneal signs may be absent in
pregnancy, as the uterus can lift the
abdominal wall away from the area of
inflammation.

13. o Note the changing positions of the intra-
abdominal contents as the pregnancy
progresses. The appendix is located at
McBurney's point in patients in the first
trimester, but then moves upward and
laterally towards the gallbladder. The
bowel can be displaced into the upper
abdomen

14. ◦ Biochemistry: renal and liver function,
glucose, calcium, amylase.
◦ Clotting screen if haemorrhage, placental
abruption or liver disease suspected.
◦ Sickle cell screen.
◦ Blood film (for evidence of haemolysis, if
HELLP syndrome is suspected).

15. ◦ Urine tests:
-Urine microscopy and culture.
-Urine protein quantification for
suspected pre-eclampsia.
◦ ECG : if atypical epigastric pain.
◦ Ultrasound.

16.  assessment of the wellbeing of the mother
and fetus and possible underlying causes
are required.
 Treatment according to cause; hospital
referral if uncertain cause, or maternal or
fetal distress.
 If surgery is deemed necessary during
pregnancy, perform it in the second
trimester if possible.
 Laparotomy (or perhaps laparoscopy but
not in late pregnancy) is indicated if the
diagnosis is in doubt .

17. Thank you for attention