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Thread: Abdominal pain during pregnancy

  1. #1
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    Nov 2006
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    Default Abdominal pain during pregnancy

    Is it normal to have some abdominal pain during pregnancy?
    What serious problems can cause abdominal pain during pregnancy?
    What are the most common causes of harmless abdominal discomfort?
    Is it normal to have some abdominal pain during pregnancy?

    Occasional abdominal discomfort is a common pregnancy complaint, and while it may be harmless, it can also be a sign of a serious problem. (Severe or persistent abdominal pain should never be ignored.)

    Below we'll describe the most common causes of abdominal pain and discomfort during pregnancy, but don't try to diagnose yourself. If you experience abdominal pain or cramping along with spotting, bleeding, fever, chills, vaginal discharge, faintness, discomfort while urinating, or nausea and vomiting, or if the pain doesn't subside after several minutes of rest, call your practitioner.

    What serious problems can cause abdominal pain during pregnancy?

    Ectopic pregnancy
    An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes. It usually causes symptoms at about six or seven weeks after fertilization, but symptoms may occur as early as four weeks, before you even know you're pregnant.

    If left untreated, an ectopic pregnancy can rupture and be life threatening. Call your practitioner immediately if you have any of the following symptoms: abdominal or pelvic pain or tenderness, vaginal spotting or bleeding (can be red or brown, copious or scant, continuous or intermittent), pain that gets worse during physical activity or while moving your bowels or coughing, or pain in the tip of your shoulder.

    If you're bleeding heavily or having signs of shock (such as a racing pulse, dizziness, fainting, or pale, clammy skin), call 911.

    Miscarriage is the loss of a pregnancy in the first 20 weeks. Vaginal spotting or bleeding is generally the first symptom, followed by abdominal pain a few hours to a few days later.

    The bleeding may be light or heavy. The pain may feel crampy or persistent, mild or sharp, and may feel more like low back pain or pelvic pressure.

    Call your practitioner if you have signs of a miscarriage. If you have severe pain or heavy bleeding, you need to be seen immediately.

    Preterm labor
    You're in preterm labor (also known as premature labor) if you start to have contractions that efface or dilate your cervix before 37 weeks of pregnancy.

    Call your doctor or midwife right away if you're having any of the following symptoms in your second or third trimester (before 37 weeks):

    An increase in vaginal discharge or a change in the type of discharge (if it becomes watery, mucus-like, or bloody even if it's just pink or tinged with blood)

    Vaginal spotting or bleeding

    Abdominal pain, menstrual-like cramping, or more than four contractions in one hour (even if they don't hurt)

    An increase in pressure in the pelvic area

    Low back pain, especially if you didn't previously have back pain.

    Placental abruption
    Placental abruption is a serious condition in which your placenta separates from your uterus, partially or completely, before your baby's born.

    There's wide variation in symptoms. A placental abruption can sometimes cause sudden and obvious bleeding, but in other cases there may not be any noticeable bleeding at first, or you might have only light bleeding or spotting. Or you might see bloody fluid if your water breaks.

    You might have uterine tenderness, back pain, or frequent contractions, or the uterus might contract and stay hard like a cramp or contraction that doesn't go away. You might also notice a decrease in your baby's activity. Immediate medical attention is a must.

    Preeclampsia is a complex disorder of pregnancy that causes changes in your blood vessels and can affect a number of organs, including your liver, kidneys, brain, and the placenta. You're diagnosed with preeclampsia if you have high blood pressure and protein in your urine after 20 weeks of pregnancy.

    Symptoms may include swelling in your face or puffiness around your eyes, more than slight swelling in your hands, and excessive or sudden swelling of your feet or ankles. (This water retention can lead to a rapid weight gain.)

    With severe preeclampsia, you may have intense pain or tenderness in the upper abdomen, a severe headache, visual disturbances (such as blurred vision or seeing spots), or nausea and vomiting. If you have symptoms of preeclampsia, call your doctor or midwife immediately.

    Urinary tract infections
    Being pregnant makes you more susceptible to urinary tract infections of all kinds, including kidney infections.

    Symptoms of a bladder infection may include pain, discomfort, or burning when urinating; pelvic discomfort or lower abdominal pain (often just above the pubic bone); a frequent or uncontrollable urge to pee, even when there's very little urine in the bladder; and cloudy, foul-smelling, or bloody urine. Call your caregiver if you have any of these symptoms because an untreated bladder infection can lead to a kidney infection and premature labor.

    Signs that the infection has spread to your kidneys and that you need medical attention immediately include a high fever, often with shaking, chills, or sweats; pain in your lower back or in your side just under your ribs, on one or both sides (and possibly in your abdomen as well); nausea and vomiting; and possibly pus or blood in your urine.

    Other causes

    Many other conditions can cause abdominal pain, whether you're pregnant or not. Some of the most common causes of abdominal pain that your practitioner will consider are a stomach virus, food poisoning, appendicitis, kidney stones, hepatitis, gallbladder disease, pancreatitis, and bowel obstruction.

    Both gallbladder disease and pancreatitis are often a result of gallstones, which are more common during pregnancy. The pressure of the growing uterus on previously scarred intestinal tissue may cause bowel obstruction. It's most likely to occur in the third trimester.

    What are the most common causes of harmless abdominal discomfort?

    Not all abdominal discomfort is a sign of a serious problem during pregnancy. For example, you may notice a bit of cramping during or right after an orgasm. As long as it's mild and short-lived, it's perfectly normal and nothing to be alarmed about.

    Here are some other causes of ordinary abdominal discomfort. But remember, if you're unsure what's going on or your discomfort is severe or persistent, play it safe and call your caregiver.

    Gas and bloating
    You're much more likely to have gas pain and bloating during pregnancy because of hormones that slow your digestion and the pressure of your growing uterus on your stomach and intestines.

    Constipation is another common cause of abdominal discomfort throughout pregnancy, thanks to hormones that slow the movement of food through your digestive tract and the pressure of your growing uterus on your rectum.

    Round ligament pain
    Round ligament pain is generally a brief, sharp, stabbing pain or a longer-lasting, dull ache that you may feel on one or both sides of your lower abdomen or deep in your groin, usually starting in your second trimester. It happens when the ligaments that support your uterus in your pelvis stretch and thicken to accommodate and support its growing size.

    You may feel a short jabbing sensation if you suddenly change position, such as when you're getting out of bed or up from a chair or when you cough, roll over in bed, or get out of the bathtub. Or you may feel a dull ache after a particularly active day, if you've been walking a lot or doing some other physical activity. Call your caregiver if this discomfort continues even after you've rested.

    Braxton-Hicks contractions
    Sometime after midpregnancy, you may start to notice some tightening in your uterus from time to time. Before 37 weeks, these Braxton-Hicks contractions should be infrequent, irregular, and essentially painless.

    Call your provider if the contractions are accompanied by lower back pain, if you feel more than four contractions an hour (even if they don't hurt), if they're coming at regular intervals, or if you have any other signs of premature labor.

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  2. #2
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    Oct 2007
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    vitrag do u have any details on how to manage acute appendicitis in different trimesters of pregnancy??? plz post in obs>clinics>appendicts vs pregnancy...

  3. #3
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    Appendicitis in pregnancy:

    Appendicitis in pregnant females results in grave consequences because the appendix tends to rupture early in pregnancy. Early diagnosis of appendicitis is possible only by the combined efforts of the obstetrician and the surgeon.

    The patient is given the advantage of suspicion in the form of intervention. It has been stated that abdominal pain and vomiting with poorly localized right-sided tenderness and low-grade pyrexia in late pregnancy means appendicitis,
    unless proved otherwise , as abdominal pain has been the commonest presenting symptom. Nausea and vomiting was the commonest symptoms (81 %) in the present study, although some have not found this to be helpful .

    In the present study, there was equal incidence of pain in the right hypochondrium and right iliac fossa (27% each) compared with pain in the right flank (18%) and guarding and rebound tenderness were the most frequent signs (72 %) . Such signs should be investigated carefully and given cardinal importance keeping in view that these signs are elicited in a more lateral position of the abdomen because of presence of pregnant uterus in the patient.

    Though acute appendicitis is most likely to occur between 2nd and 6th month of pregnancy, the incidence of perforation rises from 10% in the first trimester to 40% in the third trimester with increased risk of morbidity and mortality. Two of the patients with complaint of diffuse abdominal pain were found to have appendiceal rupture and both were in the third trimester.

    Thus, acute appendicitis in the last trimester has grave prognosis as the appendix is pushed progressively upward by the growing uterus and “walling off ” of the infection becomes increasingly unlikely resulting in appendiceal rupture with widespread peritonitis .

    Appendicitis also increases the likelihood of abortion or premature labor, especially if peritonitis develops. In the present study, there was no fetal loss and there was only one case of premature labor (37th week) occurring on the second postoperative day. The effects of surgical trauma on the fetal, placental and uterine elements, lasts for approximately one week after
    appendectomy .

    Many conditions in pregnancy may simulate or be simulated by appendicitis; ovarian tumor with twisted pedicle, salpingitis, ectopic pregnancy, angular pregnancy, pyelitis, cholecystitis, duodenal ulcer and myoma undergoing red degeneration. If acute appendicitis can not be ruled out in the face of reasonably definite symptoms and signs, early appendectomy should be carried out , regardless of the stage of gestation.

    A negative appendectomy is justifiable keeping in view the morbidity and mortality associated with the impending risk of perforated appendix. It is also important that both hypoxia and hypotension are avoided during the operation and the period of recovery. The patients were given postoperative antibiotic cover against aerobes and anaerobes of the gut and tocolysis but even then one of the patients went into pre-term labor and subsequent delivery. Thus, appendectomy can precipitate the onset of labor in a small number of pregnant women.

    The result of maternal and fetal outcome in the present study was 100% as it was carried out in a tertiary care set-up but one can expect that the outcome would have been different if the study were carried out at a place with fewer medical facilities.

    Prompt surgical intervention has helped prevent maternal and fetal loss in previous studies and our series confirms this. Admittedly, the number of patients in the present study was too small to draw conclusions.


    Nausea, vomiting and abdominal pain were commonest presenting
    features of acute appendicitis in pregnant women. A combined obstetrical and surgical approach with early decision of surgery by giving the patient
    the benefit of doubt resulted in maternal and fetal safety.
    Last edited by trimurtulu; 10-17-2008 at 11:32 PM.

  4. #4
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    Aug 2009
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    Thanx Vitrag for beneficial information. I have this summary list..
    .................................................. ...........................................

    (A) Pregnancy Related Pain:

    (I) First trimester:
    1. Abortion: Inevitable, incomplete or septic abortions.
    2. Vesicular mole: when expulsion starts.
    3. Ectopic pregnancy: pain precedes bleeding.

    (II) Second trimester:
    1. Mid-trimester abortion: although abortion due to cervical incompetence is relatively painless it may be preceded by mild lower abdominal pain.
    2. Angular pregnancy ; or rupture of a rudimentary horn.
    3. Red degeneration of fibroids.
    4. Stretch of the nerve fibres in the round ligaments: pain in one or both iliac fossae between 16th and 20th week of pregnancy.

    (III) Third trimester:
    1. Abruptio placentae.
    2. Rupture uterus.
    3. Severe pre-eclampsia: associated with upper abdominal pain.
    4. Pressure symptoms:as engagement of the head , distension of the abdominal wall and pain due to flaring of the ribs particularly in breech presentation.
    5. Braxton Hicks contractions: Although it is usually painless, many women find it painful.
    6. False labour pain: irregular, not progressively increasing and not associated with bulging of forebag of water or dilatation of the cervix.
    7. Labour pain.
    .................................................. ...................

    (B) Incidental Abdominal Pain:

    (I) Genital causes:
    1. Acute salpingitis: It is rarely seen because the presence of a pregnancy in the uterus prevents ascending infection and if the disease is chronic infertility is more likely.
    2. Complicated ovarian cyst: as torsion, rupture, or haemorrhage.

    (II)Gastro-intestinal causes:
    1- Hurt burn and hiatus hernia.
    2- Peptic ulcer.
    3- Biliary diseases.
    4- Pancreatitis.
    5- Acute appendicitis.
    6- Constipation.
    7- Acute intestinal obstruction.
    8- Inflammatory bowel disease : as Crohn’s disease and ulcerative colitis.

    (III) Renal causes:
    2-Renal calculi.
    3-Acute retention of urine.

    (IV) Miscellaneous:
    1- Vascular accidents : e.g.
    2- rectus sheath haematoma,
    3- mesenteric thrombosis, and
    4- rupture spleen or splenic aneurysm.
    5- Malignant lesions.
    6- Porphyria.

  5. #5
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    Oct 2010
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    Thank you all for sharing this information......

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