Abdominal Pain During Pregnancyِ : Abdominal Pain During Pregnancyِ Dr.Samir Fouad AbdelAziz
Al-Azhar University Slide 2: 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 : First Trimester Abortion
Disturbed Ectopic pregnancy
pregnancy in rudimentary horn
Acute Retention of urine First Trimester pain : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : Third Trimester Pain Concealed haemorrhage
Red degeneration of fibromyoma
Contractions of labour Third Trimester Pain : 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 : 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 : 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 : 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 : 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 : 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 Slide 19: *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 Slide 20: *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.) : 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 : 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 : 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.) : 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.) : 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.) : 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.) : Incidental Causes(cont.) Other causes