Obstetrics Simplified - Diaa M. EI-Mowafi
Abdominal Pain with Pregnancy
Pregnancy Related Pain
First trimester
- Abortion: Inevitable, incomplete or septic abortions.
- Vesicular mole: when expulsion starts.
- Ectopic pregnancy: pain precedes bleeding.
Second trimester
- Mid-trimester abortion: although abortion due to cervical incompetence is relatively painless it may be preceded by mild lower abdominal pain.
- Angular pregnancy ; or rupture of a rudimentary horn.
- Red degeneration of fibroids.
- Stretch of the nerve fibres in the round ligaments: pain in one or both iliac fossae between 16th and 20th week of pregnancy.
Third trimester
- Abruptio placentae.
- Rupture uterus.
- Severe pre-eclampsia: associated with upper abdominal pain.
- Pressure symptoms: as engagement of the head, distension of the abdominal wall and pain due to flaring of the ribs particularly in breech presentation.
- Braxton Hicks contractions: Although it is usually painless, many women find it painful.
- False labour pain: irregular, not progressively increasing and not associated with bulging of forebag of water or dilatation of the cervix.
- Labour pain.
Incidental Abdominal Pain
Genital causes
- 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.
- Complicated ovarian cyst: as torsion, rupture, or haemorrhage.
Gastro-intestinal causes
- Hurt burn and hiatus hernia.
- Peptic ulcer.
- Biliary diseases.
- Pancreatitis.
- Acute appendicitis.
- Constipation.
- Acute intestinal obstruction.
- Inflammatory bowel disease: as Crohn’s disease and ulcerative colitis.
Renal causes
- Pyelonephritis.
- Renal calculi.
- Acute retention of urine.
Miscellaneous
- Vascular accidents: e.g.
- rectus sheath haematoma,
- mesenteric thrombosis, and
- rupture spleen or splenic aneurysm.
- Malignant lesions.
- Porphyria.
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