Abdominal Pain in pregnancy > 12weeks gestation

Table of content

• 1. Assessment

• 2. History

• 3. Examination

• 4. Common Causes

• 5. Reference

Abdominal Pain In Pregnancy (>12wks)

DR JUDITH KUNDODYIWA MRCOG (Consultant O&G)

ASSESSMENT

• History:
  • Location, nature and duration of pain.
  • Pain worse on movement?
  • Any tightening?
  • Urinary symptoms?
  • Bowel symptoms?
  • Any PV loss?
  • Normal foetal movements?

• Examination:
  • Check observations (including BP)
  • Abdominal, obstetric palpation including fundal height
  • Speculum examination.
  • CTG if >28wks.
  • Urine dipstick.
  • Check position of placenta on scan report.

Common Causes And Management

• UTI
  • If CTG satisfactory (i.e. no excessive uterine irritability) and patient able to tolerate oral medication, discharge with cefalexin 500mg TDS  for 7 days.
  • Await Microscopy, culture and sensitivity results if asymptomatic
  • Treat asymptomatic bacteriuria
• Constipation
• Pelvic Girdle And Round Ligament Pain
  • Pain worse with movement.
  • Advise rest and simple analgesia (paracetamol, codeine).
  • Refer to physio if severe.

• Trauma / Falls
  • If abdomen is not-tender, no Per Vagina loss and CTG reassuring – discharge.
  • If Rhesus negative give anti-D
  • If any concerns, admit and observe.
• Braxton-Hicks Contractions
• Threatened Premature Labour
  • Admit if excessive uterine irritability on CTG or cervical os open / bulging membranes.
  • Inform Specialist registrar
  • Give analgesia – paracetamol and codeine.
  • Consider transfer to CDS for nifedipine / atosiban.
  • Administer corticosteroids for fetal lung maturation between 24-34 weeks gestation if fetal fibronectin is positive or cervical os is opened

• Pre-eclampsia
  • Request BP profile
  • Give labetalol 200mg PO.
  • Repeat dose after 30minutes if BP not improving.
  • After 2 stat doses of labetalol, consider transfer to CDS for IV labetalol if BP still elevated.

• Placental Abruption
  • Often but not always associated with PV bleed.
  • CTG often shows non-reassuring foetal trace.
• Chorioamnionitis
• Uterine Rupture
  • May present with ‘scar pain’ in patient with hx of LSCS.

• Fibroids
  • More common in black women
  • Presents with severe localised pain +/- fever.
  • There may be raised White Cell Count and CRP
  • Perform USS and give analgesia including opoids

• Ovarian Cysts
  • Check USS reports
  • Cysts <5cm in 1^st trimester are common and usually resolve spontaneously
  • May present with torsion – pain, nausea, vomiting, ↑temp, ↑WCC, ↑CRP.

• Indigestion
  • Gaviscon
  • Advise small, regular meals and avoiding eating late at night.

• Biliary Colic / Cholecystitis
  • Request bloods – FBC, Electrolytes and Urea, CRP, LFTs, amylase
  • Request upper abdominal USS.
  • Request surgical team review.

• Appendicitis
  • Request bloods – FBC, U+Es, CRP
  • Keep nil by mouth
  • Inform Specialist registrar and request surgical review.

Reference