Abdominal Pain During

Pregnancy
Augustinus BT

 Abdominal pain is a very common symptom in

pregnant women. It may be due to pregnancy
itself e.g red degeneration in a fibroid or may
arise from some concomitant lesion such as
appendicitis.
It is convenient to divide the causes of pain due
to pregnancy into those most commonly found in
each of the three trimesters,though of course
there is considerable overlap

First Trimester

Abortion
Disturbed Ectopic pregnancy
pregnancy in rudimentary horn
Acute salpingitis
Acute Retention of urine

First Trimester pain

Abortion
Pain preceeded by vaginal bleeding,
in the middle &intermittent.
Cervix,closed(threatened abortion)or open
(inevitable)..U/S.gestational sac inside
uterine cavity.

First Trimester Pain

Ectopic pregnancy
Pain typically occur before bleeding and blood
tend to be dark(prune juice)
Pain tends to be limited initially to the affected
side,though if interperitoneal bleeding occurs
it become generalised & the picture of acute
abdomen may develop with shock

First Trimester Pain

Pregnancy in rudimentary
horn
pain resemble that of ectopic and usually
the condition discovered during laparotomy
If rupture occurs it usually in the
midtrimester and of sudden onset with
collapse

First Trimester Pain

Acute Salpingitis
May develop up to the 10th.weeks after
conception,due to gonococcal infection or
infection at attempted attempted abortion
Pain felt in both iliac fossae & is continuous
There is associated tenderness,tachycardia and
elevated temperature,culture of discharge may
reveal pathogens

First Trimester Pain

Acute retention of urine
is usually due to enlargement of a cervical
fibroid in response to pregnancy and may
occur very early
Severe lower abdominal wall, large tender
bladder which may be mistaken for ov. Cyst
Catheterisation causes immediate relief of pain

Midtrimester Pain
Acute retention of urine due to incarcerated
RVF gravid uterus
Red degeneration in a fibromyoma
Rupture of rudimentary horn containing
pregnancy
Stretching of round ligament
Abortion

Midtrimester Pain
Red degeneration of fibromyoma
causes pain ranging from mild to severe over
the fibroid.tenderness usually present over the
fibroid.
U/S usually detect the fibroid during first
trimester
There may be history of menorrhagia before
pregnancy..TT..conservative with analgesic

Midtrimester Pain
Stretching of the round ligament may
sometimes be a cause of mid-trimester pain
Usually pain is continuous and there is
tenderness over the affected ligament
There is no constitutional symptoms.
Reassurance and sometimes mild analgesia
is required

Third Trimester Pain

Concealed haemorrhage
Severe preeclampsia
Red degeneration of fibromyoma
Uterine rupture
Contractions of labour

Third Trimester Pain

Concealed haemorrhage
Pain is of acute onset & is severe, with considerable
shock and collapse.
The abdominal ms. Are tense and the uterus may be
larger than expected, hard tender with difficulty in
palpating fetal parts
Fetal heart is usually absent
there may be vagina bleeding
There may be hypertension before the event

Third Trimester Pain

Severe Pre-eclampsia
Epigastric pain may occur & is a sign of
impending eclampsia.
The characteristic signs of pre-eclampsia,
hypertension, proteinuria and oedema are
present
The uterus is not tender & fetal parts are
palpable & FHR usually present

Third Trimester Pain

Uterine rupture is a possibility in highly
parous women & those who have scarred
uterus by CS,Myomectomy or perforation.
Women usually feel a tearing sensation
followed by constant pain..shock &
collapse. Vaginal bleeding is common.
Fetal parts easily felt & FHR is absent

Third Trimester Pain

Labour pains
may occur prematurely or at term, they are
intermittent & gradually become stronger
and more frequent.
The characteristic show of early labour will
be observed and on vaginal examination
cervix will be taken up and perhaps dilated

Incidental Causes of Pain

Gastro-enteritis
Pain is generalised over the abdomen and
accompained by vomiting and diarrhoea.
Temperature is elevated and abdomen is
tender with no rigidity
stool analysis show organism

Incidental causes of Pain

Acute Appendicitis and
Pyelonephritis
the appendix is displaced upward
and laterally as pregnancy advances
and its tip overly the tip of right
kidney. Appendicitis may be
confused with pyelonephritis

 *In pyelonephritis the pain is often of an

aching character and felt only in the lumbar
region, however, it may be felt only in the
right side of abdomen & in severe cases
may be diffused over the whole abdomen
*in pyelonephritis the tenderness is usually
localised in the right costovertebral angle

 *In pyelonephritis temperature tend to be

high and pulse rate in relation to temperature
tend to be lower than in case of appendecitis
*Even with sever cases the tongue is usually
moist in cases of pyelonephritis,but usually
dry with appendicitis.
In case of doubt laparotomy is indicated, to
avoid mortality with appendicitis

Incidental causes(cont.)
Renal and uretric calculi
Pain may be confused as pyelitis and radiate
to leg. Blood may be present in the urine and
U/S may show stone in kidney or bladder.
Acute cholycystitis..usually positive history
present and pain over Rt.hypochondrium,
radiate to Rt.shoulder.U/S may show stone in
G.B

Incidental causes of Pain

Perforation of a hollow organ
such as the stomach or duodenum, may
occur with sudden pain, collapse and the
rapid development of generalised peritonitis
Usually history of peptic ulcer or gastric
ulcer is present

Incidental Causes of Pain

Strangulated hernia should be born in
mind and hernial sites should be examined
Acute Pancreatitis the onset is sudden
with severe upper abdominal pain &
vomiting.usually serum amylase and
urinary diastase levels elevated.
Treatment is usually conservative

Incidental causes(cont.)
Acute Hepatitis
May occur in hyperemesis gravidarum,
in sever pre-eclampsia/eclampsia or in
acute infective hepatitis. In all these
conditions there is pain & tenderness
over the liver & jandice is usually soon
manifest

Incidental Causes (cont.)

Acute intestinal obstruction
Sometimes found in pregnancy & usually
there is history of laparotomy & if there is
band of adhesion the enlarged uterus
displaces the intestine & obstruction
occurs.The onset is usually sudden,with
vomiting. Distention & vomiting with
colicky pains are typical.

Incidental Causes(cont.)
Torsion of ovarian cyst may occur
especially during first trimester. Pain is at first
referred to one or other hypochondrium & is
acute in onset usually with vomiting.
as peritonitis occur there is pain, tenderness &
rigidity over the tumor.there may be some
pyrexia.
U/S show the cyst

Incidental Causes(cont.)

Other causes
Acute porphyeria
Sickling crisis
Diabetic ketoacidosis