Abdominal Pain During Pregnancy by Abhishek Jaguessar

8/4/2019 Abdominal Pain During Pregnancy by Abhishek Jaguessar

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Abdominal Pain DuringPregnancy

BY

ABHISHEK JAGUESSAR


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Abdominal pain is a very common

symptom in pregnant women. It may be due

to pregnancy itself e.g red degeneration in afibroid or may arise from some concomitant

lesion such as appendicitis.

It is convenient to divide the causes of paindue to pregnancy into those most commonly

found in each of the three trimesters,though

of course there is considerable overlap


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First Trimester

Abortion

Disturbed Ectopic pregnancy

pregnancy in rudimentary horn

Acute salpingitis

Acute Retention of urine


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First Trimester pain

Abortion

Pain preceeded by vaginal bleeding, in the middle &intermittent.

Cervix,closed(threatened abortion)or open

(inevitable)..U/S.gestational sac insideuterine cavity.


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First Trimester Pain

Ectopic pregnancy

Pain typically occur before bleeding andblood tend to be dark(prune juice)

Pain tends to be limited initially to the

affected side,though if interperitonealbleeding occurs it become generalised & the

picture of acute abdomen may develop with

shock


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Pregnancy in rudimentary

horn pain resemble that of ectopic and usually

the condition discovered during laparotomy

If rupture occurs it usually in themidtrimester and of sudden onset with

collapse


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Acute Salpingitis

May develop up to the 10th.weeks afterconception,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


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Acute retention of urine

is usually due to enlargement of a cervicalfibroid in response to pregnancy and may

occur very early

Severe lower abdominal wall, large tenderbladder which may be mistaken for ov. Cyst

Catheterisation causes immediate relief of

pain


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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


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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


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Midtrimester Pain

Stretching of the round ligament maysometimes 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


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Third Trimester Pain

Concealed haemorrhage

Severe preeclampsia

Red degeneration of fibromyoma

Uterine rupture

Contractions of labour


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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


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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


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Uterine rupture is a possibility inhighly parous women & those who have

scarred uterus by CS,Myomectomy orperforation.

Women usually feel a tearing sensation

followed by constant pain..shock &collapse. Vaginal bleeding is common.

Fetal parts easily felt & FHR is absent


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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


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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


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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 rightkidney. Appendicitis may be

confused with pyelonephritis


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*In pyelonephritis the pain is often of an

aching character and felt only in the lumbar

region, however, it may be felt only in theright side of abdomen & in severe cases

may be diffused over the whole abdomen

*in pyelonephritis the tenderness is usuallylocalised in the right costovertebral angle


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*In pyelonephritis temperature tend to be

high and pulse rate in relation to

temperature tend to be lower than in case ofappendecitis

*Even with sever cases the tongue is usually

moist in cases of pyelonephritis,but usuallydry with appendicitis.

In case of doubt laparotomy is indicated, to

avoid mortality with appendicitis


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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


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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


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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 andurinary diastase levels elevated.

Treatment is usually conservative


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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 soonmanifest


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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,withvomiting. Distention & vomiting with

colicky pains are typical.


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Incidental Causes(cont.)

Torsion of ovarian cyst may occurespecially 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 besome pyrexia.

U/S show the cyst


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Incidental Causes(cont.)

Other causes

Acute porphyeria

Sickling crisis

Diabetic ketoacidosis

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Abdominal Pain During Pregnancy by Abhishek Jaguessar