Abdominal pain in pregnancy is common. Many adaptive or physiologic 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 physiologic and anatomic 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 gynecologic and gastrointestinal origin. Pain may be due not only to pregnancy-specific causes or gynecologic 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 onward.
Evaluation is based on 2 patients: the mother and the fetus. The potential adverse effects of anesthesia, 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 nonpregnant 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 nonspecific and are often altered due to physiologic changes in pregnancy.
Despite advances in medical technology, preoperative diagnosis of acute abdominal conditions can still be inaccurate, increasing the rate of exploratory laparotomy, cesarean section, premature delivery, and perinatal death.
- Ectopic pregnancy
- Preterm labor
- Adnexal mass
- Acute cystitis
- Placental abruption
- Uterine rupture
- Acute pyelonephritis
- Acute hydronephrosis
- Ruptured ovarian cyst
- Hemorrhagic ovarian cyst
- Adnexal torsion
- Acute pancreatitis
- Intestinal obstruction
- Uterine fibroids
- Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome
- Acute fatty liver of pregnancy
- Ovarian hyperstimulation syndrome
- Splenic rupture
- Rectus sheath hematoma
Pasquale Berlingieri, MBBS, MD, PhD
Specialist in Obstetrics and Gynecology
Head of Virtual Reality (Screen-Based) Simulation Centre
The Royal Free Campus
University College London
PB declares that he has no competing interests.
Jurgis Gediminas Grudzinskas, BSc, MBBS, MD, FRCOG, FRACOG
Formerly Emeritus Professor of Obstetrics and Gynecology
St Bartholomew's and the Royal London Hospital School of Medicine
JGG is an author of a number of references cited in this topic.
John Bachman, MD
Consultant in Family Medicine
Parker D Sanders and Isabella Sanders Professor of Primary Care
JB declares that he has no competing interests.
Rhona Hughes, MBChB
Lothian Simpson Centre for Reproductive Health
The Royal Infirmary
RH declares that she has no competing interests.
Samuel J. Stratton, MD, MPH
UCLA School of Public Health and David Geffen School of Medicine
Health Disaster Management/Emergency Medical Services
Orange County Health Care Agency
SJS declares that he has no competing interests.
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