Monday, July 8, 2013

Complete Guide for Abdominal Pain during Pregnancy

Roger Mitnick  /  at  10:00 PM  /  No comments

 
ABDOMINAL PAIN DURING PREGNANCY HAS MANY REASONS

The abdomen is roofed by the diaphragm, which separates it from the thorax (chest). • At the front and sides is the abdominal wall: skin, fat and muscles. 

• At the back, the spine (vertebral column) . 

• It is completely filled with the abdominal organs: These are all covered by a thin membrane, continuous with that which also lines the inside of the abdominal wall (peritoneum). 

• The abdominal cavity and its peritoneal lining are continuous below with those of the pelvis.

Management of abdominal pain in pregnancy 

• A thorough assessment of the wellbeing of the mother and fetus, as well as the possible underlying cause is required. • Treatment of cause: urgent hospital referral if uncertain cause, and/or maternal or fetal distress.

 • If surgery is required but is considered elective, waiting until after it is completed is prudent.

 • A pregnancy in a woman with an intra-abdominal inflammatory disease will not be harmed by proper surgical treatment. The fetus is more likely to be damaged if the proper operation is delayed. 

• Laparotomy (or perhaps laparoscopy but not in late pregnancy) is indicated if the diagnosis is in doubt or if there is shock.


INVESTIGATIONS OF ABDOMINAL PAIN DURING PREGNANCY

• When evaluating the gravid patient with acute abdominal pain, remember that some very commonly used laboratory tests have altered reference ranges in pregnancy. These changes can make the initial evaluation process somewhat more difficult.

find abdominal pain during pregnancy with these tests

 • Fetal monitoring

 • Urinanalysis, MSU: infection, proteinuria in pre-eclampsia 

• Full blood count: raised white cell count suggestive of infection
, although the white cell count is normally slighty raised in pregnancy 

• Liver function tests 

• Ultrasound: may demonstrate ectopic pregnancy, abruption, miscarriage 

• Magnetic resonance imaging : The intrinsic safety of MRI and its ability to accurately show abdominal and pelvic disease in pregnant patients make it highly useful in the evaluation of these patients. 

• Laparoscopy to confirm ectopic pregnancy - Laparoscopy has become increasingly popular in the treatment and evaluation of acute abdomen. In the past, pregnancy was considered a contraindication for laparoscopy ,  Care must be taken to minimize manipulation of the uterus. Adjust the location of trocar placement based on uterine size. Monitor fetal heart tones during the surgical procedure


CAUSES OF ABDOMINAL PAIN DURING PREGNANCY

(A) Pregnancy Related Pain: 

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

• Later pregnancy 


o Braxton-Hicks Contraction

o Round Ligament Pain
o Pressure symptoms
o Cholestasis of pregnancy
o Placental abruption
 o Placenta percreta
 o Acute Fatty Liver
 o Pre-eclampsia , HELLP
 o Spontaneous rupture of the liver
o Uterine rupture
 o Chorioamnionitis
o Acute Polyhydramnios o Labor ( Term , Preterm )


• Conditions associated with pregnancy 

• Rupture of rectus abdominus muscle
• Torsion of the pregnant uterus
 • Acute urinary retention due to retroverted gravid uterus
• MusculoSkeletal ( Pubic Symphysis pain-sacroiliac – back pain ).
 •  Red degeneration of myoma.
 • Torsion of pedunculated myoma
• Ovarian cyst rupture.
 •  Adnexal torsion


© Non-Pregnancy Related  Pain


 • Gastrointestinal o Acute appendicitis

o Peptic ulcer
o Gastroenteritis
 o Hepatitis o Inflammatory Bowel  Complication (Crohn’s &Ulcerative Colitis )
o Bowel obstruction
o Bowel perforation o Herniation
 o Meckel diverticulitis
o Toxic megacolon
 o Pancreatic pseudocyst HepatoBliary
 o Biliary Stones o Acute Hepatitis
o Acute Cholecystitis
o Acute pancreatitis

• Genitourinary

o Ureteral calculus
 o Acute pyelonephritis
o Acute cystitis
o Rupture of renal pelvis
 o Ureteral obstruction

• Vascular

o Superior mesenteric artery syndrome
 o Thrombosis/infarction
- Specifically mesenteric venous thrombosis
o Ruptured visceral artery aneurysm

• Respiratory o Pneumonia


• Other

o Intraperitoneal hemorrhage
o Splenic rupture
 o Abdominal trauma
 o Acute intermittent porphyria
o Diabetic ketoacidosis
 o Sickle cell disease

Generally abdominal pain can also be observed in women if they have some ovarian cyst rupture or fibroids which are growing inside their uterus and this can really lead to abdominal pain and sometimes abdominal surgery.

pain can be occured inside the abdomen area in pregnancy
It is so hence advised that you see all the list of above reasons why you get the pain during pregnancy.

Consult your gynaecologist or doctor and get them tested for all the tests and if you get positive , then you have to take steps to remove them because this can lead to ultimate damage of your abdomen

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