Abdominal Pain In Pregnancy Research Articles

Strangulated congenital diaphragmatic hernia with partial gastric necrosis: a rare cause of abdominal pain in pregnancy

Strangulated congenital diaphragmatic hernia with partial gastric necrosis: a rare cause of abdominal pain in pregnancy

Intussusception: a rare cause of abdominal pain in pregnancy

A 34-year-old woman presented at 19 weeks in her third pregnancy with abdominal pain and hyperemesis. This was her third admission during the pregnancy for similar complaints. A few days after admission an exacerbation in her pain was noted, in particular on eating or lying down, and a firm and mobile epigastric mass could be palpated separate from her uterus. The differential diagnosis was a hernia or a degenerating pedunculated fibroid. Sonography revealed a mass separate from the uterus with an appearance consistent with intussusception. Magnetic resonance imaging confirmed the diagnosis. A limited right hemicolectomy was performed. The final diagnosis was adenocarcinoma of the colon. It is difficult to diagnose intussusception during pregnancy. The presenting symptoms of nausea, vomiting, abdominal pain and constipation are common in pregnancy and the displacement of the bowel by the gravid uterus hampers examination. Intussusception is very rare in adults and generally it is associated with tumors. Preoperative diagnosis is difficult but possible with accurate imaging.

Acute abdomen and abdominal pain in pregnancy

Abdominal pain in pregnancy poses a diagnostic and management challenge to the attending physician. Many causes are specific to pregnancy, but conditions affecting the non-pregnant woman can also complicate pregnancy. Identifying the cause is influenced by the anatomical and physiological changes of pregnancy. When diagnosis and symptom control fail after 6–8 h a multidisciplinary approach should be considered. The safety and the possibility of a systematic cross-sectional evaluation of the entire abdomen have been important reasons for the use of magnetic resonance imaging in pregnancy with intractable pain. Laparoscopic surgery when appropriate is now proving to be as safe as open surgery in pregnancy. Updating knowledge and assessment skills is essential in the management of abdominal pain in obstetric triage settings.

MRI Appears Safe, Effective for Acute Abdominal Pain in Pregnancy

MRI Appears Safe, Effective for Acute Abdominal Pain in Pregnancy

MRI of Right-Sided Abdominal Pain in Pregnancy

MRI of Right-Sided Abdominal Pain in PregnancyAimee D. Eyvazzadeh1, Ivan Pedrosa2, Neil M. Rofsky2, Bettina Siewert2, Norman Farrar2, Jodi Abbott1 and Deborah Levine1 2Audio Available | Share

Acute abdominal pain in pregnancy

A 19-year-old gravida 2, para 0 woman at 17 weeks gestation, with one prior elective termination of pregnancy, presented after waking at 4:30 a.m. with sharp, severe right lower quadrant abdominal pain. The patient denied any prior symptoms, including vaginal bleeding or discharge, fever, nausea, vomiting, and painful urination. The patient stated she “felt fine” prior to waking with this pain. At presentation she was laying on her side in a fetaltype position holding her abdomen. The vital signs were as follows: temp 36.6°C, blood pressure 130/72 mm Hg, pulse 108 beats/min, and respirations 18 breaths/min with an oxygen saturation of 99% on room air. Physical examination was remarkable for marked localized tenderness in the right lower quadrant with voluntary guarding. Peritoneal signs otherwise were absent. The pelvic examination was significant for a gravid uterus about 18–20 weeks in size. Marked cervical motion tenderness was present as well as a large firm mass in the right adnexa. No vaginal bleeding or discharge was noted and the cervical os was closed. Fetal heart tones were documented at 150 beats/min. A portable ultrasound done in the Emergency Department demonstrated a large 10 10 cm adnexal cystic mass (Figure 1). Also noted was an intrauterine gestation with cardiac activity and fetal movement consistent with a 17-week gestation. The radiologic ultrasound examination confirmed an 8 10 cm cystic mass with a dermoid component on the right ovary (Figure 2). The arterial flow to that ovary was noted to be diminished, consistent with a torsion. The OB/GYN resident was notified of the findings. Immediate laparoscopic surgery was performed, demonstrating a right ovarian dermoid cyst along with an infarcted, necrotic right ovary, which was removed (Figures 3 and 4). The patient did well following the procedure despite an 8% chance of fetal demise. The patient continues to do well with subsequent follow-up visits to the obstetrician.

Obstetric triage revisited: update on non-obstetric surgical conditions in pregnancy

New findings and diagnostic advances warrant revisiting key features of acute non-obstetric abdominal pain in pregnancy. Four of the most frequently seen conditions warranting surgical intervention are: appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Because pregnancy often masks abdominal complaints, effectively assessing and triaging abdominal pain in pregnant women can be difficult. Working in obstetric triage settings and triaging obstetric phone calls demand continual updating of abdominal assessment knowledge and clinical skills.

Acute abdomen and abdominal pain in pregnancy

Abdominal pain in pregnancy continues to pose a diagnostic and management challenge to the attending obstetrician. Many causes are specific to pregnancy but conditions affecting the non-pregnant woman can also complicate pregnancy. Identifying the cause is influenced by the anatomical and physiological changes of pregnancy. There will be a reluctance to employ abdominal X-rays and laparotomy but these reservations have to be re-evaluated when symptoms fail to settle.

Abdominal pain in pregnancy

Abdominal pain in pregnancy

Abdominal pain in pregnancy: diagnosis, surgery and anaesthesia

Abdominal pain in pregnancy: diagnosis, surgery and anaesthesia

Abdominal pain in pregnancy: who needs to be admitted? Admissions in a district general hospital in one year

SummaryThis is a retrospective study of all pregnant women between 20 and 37 weeks admitted to a district general hospital in one year with a presenting complaint of abdominal pain alone (for example, with no bleeding). The outcome of the admission was correlated with important symptoms and signs present at admission. Most patients were never diagnosed. No harm would have been done if those patients with no uterine, other abdominal tenderness or loin tenderness, had not been admitted, unless other features such as peritonism or a positive urine culture were present. Pregnant patients with abdominal pain do not need to be admitted routinely if a proper assessment is carried out. Those who do need admission are identifiable at their first presentation.

Superior mesenteric artery aneurysm: A rare cause of abdominal pain in pregnancy

Superior mesenteric artery aneurysm: A rare cause of abdominal pain in pregnancy

Acute Abdominal Pain in Pregnancy

Some degree of abdominal pain is virtually physiologic in pregnancy, for which reason these women will commonly present to the emergency physician for clinical evaluation. Appendicitis is the commonest nonobstetric surgical malady complicating pregnancy; however, its clinical presentation may resemble several other surgical as well as medical entities reviewed in this article. The clinical evaluation of these patients is generally confounded because the symptoms typical of these illnesses are common to pregnancy itself, and the physical examination of the abdomen is hampered by the pregnant state. Nevertheless, prompt clinical diagnosis and surgical intervention when indicated is necessary to minimize maternal and especially fetal mortality. The general reluctance to use conventional radiographic study of these patients must be dismissed whenever the physician is confronted with severely ill or unstable patients. Whenever diagnosis is uncertain, liberal use of surgical and obstetric consultants is warranted.

ABC of antenatal care. Abdominal pain in pregnancy.

Inevitable miscarriage. Pain in the stomach brings a woman to her doctor's surgery early, especially when she is pregnant. In most such cases the problem is not serious, but all cases need careful assessment as some women will need an immediate opinion at the hospital, some can wait till the next day, and others can wait till the next antenatal clinic. Abdominal pain is diagnosed mostly by clinical means. The history and examination are most important, investigations being less helpful than in other branches of medicine. The use of ultrasonography by clinical gynaecologists has considerably improved the understanding of pelvic pathology. A vaginal transducer may give better images in early pregnancy than abdominal transducers; however, the laparoscope is still a major investigative tool for lower abdominal pain in early pregnancy. Under appropriate anaesthesia a good view of the pelvis and its organs clinches a diagnosis; in some cases treatment is also possible at the same time. Pain arises either from inside an organ, involving the covering visceral peritoneum or from later involvement of the parietal peritoneum. The visceral aspects of the pain are poorly localised as they are mediated by the autonomie nervous system. Once the parietal peritoneum is affected, however, impulses travel by the somatic route and localisation may be more specific. Nausea and vomiting occur early in many pelvic conditions as well as in normal pregnancy, which might confuse the picture. Abdominal distension is not usual unless the alimentary tract is involved secondarily; furthermore, it is masked in mid and late pregnancy by the enlarging uterus. Shock may occur if acute pain is accompanied by sudden deterioration in the woman's condition such as in real hypovolaemia due to blood loss at a ruptured ectopic pregnancy or in relative hypovolaemia after excessive autonomie stimulation from peritoneal irritation of an abruptio placentae. For the sake of analysis, in this article the commoner causes of abdominal pain in pregnancy are considered as occurring in either late or early pregnancy, but some conditions can occur in both. The causes will be considered under only one heading, which does not mean, however, that they do not occur in the other half of pregnancy.

The Rarer Causes of Abdominal Pain in Pregnancy

The Rarer Causes of Abdominal Pain in Pregnancy

ABDOMINAL PAIN IN PREGNANCY

Abdominal pain in pregnancy is frequent and has not been thoroughly studied. Few pregnant women escape some abdominal discomfort or distress. Eighty-five per cent definitely complain of such pain at some time during the nine months. The literature on the subject is meager. Brief references are scattered through obstetric textbooks.1Only two journal articles in English could be found;2hence this clinical study of abdominal pain in 300 consecutive private obstetric cases. Since it is entirely unpractical to attempt to name all the causes of abdominal pain, with or without pregnancy, this paper will deal only with abdominal pain that is directly caused by or closely associated with the enlarging uterus or the pregnant state. Pregnancy is, of course, not immune to any of the numerous intra-abdominal and extra-abdominal conditions that cause pain in the abdomen, a fact to be most strongly emphasized and ever borne in mind.

Abdominal Pain in Pregnancy

Abdominal Pain in Pregnancy