☰ Menu

Obstetrics Simplified - Diaa M. EI-Mowafi

Abdominal Pain with Pregnancy


Pregnancy Related Pain

First trimester

  • Abortion: Inevitable, incomplete or septic abortions.
  • Vesicular mole: when expulsion starts.
  • Ectopic pregnancy: pain precedes bleeding.

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

  • Hurt burn and hiatus hernia.
  • Peptic ulcer.
  • Biliary diseases.
  • Pancreatitis.
  • Acute appendicitis.
  • Constipation.
  • Acute intestinal obstruction.
  • Inflammatory bowel disease: as Crohn’s disease and ulcerative colitis.

Renal causes

  • Pyelonephritis.
  • Renal calculi.
  • Acute retention of urine.

Miscellaneous

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

Links