ABDOMINAL PAIN IN PREGNANCY

Associate Professor Dr Hanifullah Khan

CAUSES OF ABDOMINAL PAIN DURING PREGNANCY

• A. Pregnancy Related Pain: Early pregnancy

o Abortion: Inevitable, incomplete or septic abortionso Vesicular mole: when

expulsion starts. o Ectopic pregnancy: pain

precedes bleeding. Later pregnancy

o Braxton-Hicks Contractiono Placental abruption o Pre-eclampsia , HELLPo Chorioamnionitiso Labor ( Term , Preterm )

• B.Conditions associated with pregnancy

UTI Vaginal Infections• C. Non-Pregnancy Related

Pain• Gastrointestinal

o Acute appendicitis o Peptic ulcer o AGEHepatoBliaryo Biliary Stones

Genitourinary o Ureteral calculuso Acute pyelonephritis o Acute cystitis

Other o Abdominal trauma

Urinary tract infection

• Acute cystitis acute pyelonephritis and urolithiasis• Acute cystitis

- occurs in 1-2% of cases-2/3th of cases have cystitis in spite of their sterile urine at booking

Experience urinary symptoms and abdominal discomfort

Braxton Hicks contractions∗

• Sporadic uterine contractions - actually start at about 6 weeks, – although women won't be able to feel them that

early. – Usually noticeable only after midpregnancy,

• Increase in frequency as pregnancy progresses– But they remain infrequent, irregular, and

essentially painless. • Sometimes, though, hard to distinguish from

early signs of preterm labor• May get more intense and more frequent, and

cause some discomfort.∗ John Braxton Hicks, 1872.

False labour pain( Late Braxton Hicks contractions )

• Irregular,• Not progressively increasing • Not associated with bulging of forebag of water or

dilatation of the cervix.• Respond to anlgesics• Cause women confusion as to whether or not they were

going into actual labor.• They are thought to be part of the process of effacement,

the thinning and dilation of the cervix

Abortion

Miscarrage– Common in the first trimester– Vaginal bleeding– Cramp like pain– Dealt with under bleeding in pregnancy

Ectopic Pregnancy

• Most common obstetric cause of acute abdomen

• Pain usually one-sided initially– Can be confused with appendix if on the right

• May be sharp initially• Later, may be diffuse and dull• Shoulder tip pain

Placental Abruption

• Premature separation of the placenta from the uterus, – resulting in bleeding from the site of placental

attachment (concealed , revealed . Combined )• The triad of abdominal pain, uterine rigidity, and

vaginal bleeding– Suggests abruption – Also fetal tachycardia

• A tender uterus is highly suggestive• Prepare for DIC, which complicates 33% -50% of

severe cases, • Beware PPH, which is also common

Site: Contraction occurs at the uterus

Onset: Spontaneously Character: •Intermittent (comes in an irregular which then becomes regular pattern over time with one to several pain-free minutes in between them) •Increasing in frequency (Contractions almost always start off mild and gradually grow longer, stronger, and closer together) •Spasmodic (on and off) •Self-limiting (rarely takes more than 24 hours)

Radiating: Pain at uterus, which sometimes radiates to the back

Associated symptoms: Leaking of liquor,

Show

Time: 20-60 seconds per contraction

Exacerbating factors: -

Severity: mild, moderte, severe

HISTORY OF LABOUR PAIN

Preterm labour

•Definition•Classification of preterm labour•Causes of preterm labour•History and examination findings•Investigations

Definition of preterm labor

Defined as the presence of uterine contractions of sufficient frequency and intensity to effect progressive effacement and dilation of the cervix prior to term gestation (between 24+0 and 36+6 weeks)

http://emedicine.medscape.com/article/260998-overview

Classification of preterm labour

• Extremely preterm birth: 24+0 to 27+6 weeks (incidence 0.4%)

• Very preterm birth: 28+0 to 31+6 weeks (incidence 0.7%)

• Mildly preterm birth: 32+0 to 36+6 weeks (incidence 5.5%)

Extremely preterm

(24+0 to 27+6)

Very preterm

28+0 to 31+6)

Mildly preterm

(32+0 to 36+6)

Causes of preterm labour

• Infections (chorioamnitis)

• Over distension (multiple pregnancy, polyhydramnios)

• Vascular causes (eclampsia)

• Intercurrent illness (pyelonephritis)

• Cervical weakness

POSSIBLE CAUSES

History

• Ask about age of gestation, history of leaking or bleeding

• Pain

-cramp-like pain, low backache

-radiates to the back

-increase in intensity and frequency

-spontaneous onset

-not relieved by posture/ medications

-associate with liquor/show/blood

• Pelvic pressure

• Increase of vagina discharge

• Vaginal bleeding

Physical examination

• Uterus: tender (abruption/ chorioamnionitis)

• Speculum examination revealed:

-pooling of amniotic fluid

-abnormal discharge/ blood