Abdominal Pain with Pregnancy

Pregnancy Related Pain

First trimester

Second trimester

Mid-trimester abortion: although abortion due to cervical incompetence is relatively painless it may be preceded by mild lower abdominal pain.
Angular pregnancy ; or rupture of a rudimentary horn.
Red degeneration of fibroids.
Stretch of the nerve fibres in the round ligaments: pain in one or both iliac fossae between 16th and 20th week of pregnancy.

Third trimester

Abruptio placentae.
Rupture uterus.
Severe pre-eclampsia: associated with upper abdominal pain.
Pressure symptoms: as engagement of the head, distension of the abdominal wall and pain due to flaring of the ribs particularly in breech presentation.
Braxton Hicks contractions: Although it is usually painless, many women find it painful.
False labour pain: irregular, not progressively increasing and not associated with bulging of forebag of water or dilatation of the cervix.
Labour pain.

Incidental Abdominal Pain

Genital causes

Acute salpingitis: It is rarely seen because the presence of a pregnancy in the uterus prevents ascending infection and if the disease is chronic infertility is more likely.
Complicated ovarian cyst: as torsion, rupture, or haemorrhage.

Gastro-intestinal causes

Renal causes

Miscellaneous

Vascular accidents: e.g.
- rectus sheath haematoma,
- mesenteric thrombosis, and
- rupture spleen or splenic aneurysm.
Malignant lesions.
Porphyria.

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Edited by Aldo Campana,