Abdominal pain in pregnancy is common. Many adaptive or physiological changes of pregnancy affect the presentation. Women tend to visit doctors often as they are concerned about the health of their fetus. Patients require a careful assessment in order to reduce anxiety and give reassurance. If the clinical picture is unclear, a specialist should be consulted.
Diagnostic challenges and pitfalls
The physiological and anatomical changes of various organs during the course of pregnancy result in major diagnostic challenges for the clinician. Reproductive organs share the same visceral innervations as the lower ileum, sigmoid colon, and rectum. It is therefore often difficult to differentiate between pain of gynaecological and gastrointestinal origin. Pain may be due not only to pregnancy-specific causes or gynaecological conditions, but to many other diseases whose symptoms and signs may be altered significantly by the pregnant state. This is particularly true from the late second trimester onwards.
Evaluation is based on 2 patients: the mother and the fetus. The potential adverse effects of anaesthesia, drugs, and radiation on the fetus often complicate the traditional diagnostic approach. As a result, the presence of the fetus may lead to delayed intervention or invasive diagnostic tests. Furthermore, there is a general reluctance to operate unnecessarily on a gravid patient.
The acute abdomen in pregnancy remains a diagnostic dilemma. As pregnancy stretches the anterior abdominal wall, the resulting peritoneal signs are often different from what is expected in the non-pregnant patient owing to lack of contact with the underlying inflammation. In addition, the clinical picture may be distorted by the uterus obstructing the movement of the omentum to the area of inflammation. Laboratory parameters can be non-specific and are often altered due to physiological changes in pregnancy.
Despite advances in medical technology, pre-operative diagnosis of acute abdominal conditions can still be inaccurate, increasing the rate of exploratory laparotomy, caesarean section, premature delivery, and perinatal death.
- Ectopic pregnancy
- Pre-term labour
- Adnexal mass
- Acute cystitis
- Placental abruption
- Uterine rupture
- Acute pyelonephritis
- Acute hydronephrosis
- Ruptured ovarian cyst
- Haemorrhagic ovarian cyst
- Adnexal torsion
- Acute pancreatitis
- Intestinal obstruction
- Uterine fibroids
- Haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
- Acute fatty liver of pregnancy
- Ovarian hyper-stimulation syndrome
- Splenic rupture
- Rectus sheath haematoma
- ACR appropriateness criteria: right lower quadrant pain
- Ectopic pregnancy and miscarriage: diagnosis and initial management
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