Abdominal Pain Flashcards
What is most important cause to exclude?
Ectopic pregnancy
How many pregnancies are ectopic?
0.5%
What are RFs for ectopic pregnancy?
- Damage to tubes (salpingitis, surgery)
- previous ectopic
- IVF (3% of pregnancies are ectopic)
What is a typical ectopic pregnancy history?
6-8 weeks of amenorrhoea who develops lower abdo pain with PV bleed
Describe symptoms of ectopic pregnancy?
Lower abdo pain is first symptom. Unilateral and constant (due to tubal spasm).
Vaginal bleeding - usually less than a normal period and may be dark brown
Amenorrhoea - usually 6-8 weeks, if longer may suggest other causes e.g. inevitable abortion
peritoneal bleeding can cause shoulder tip pain and pain on defecation / urination
What are the types of miscarriage?
Threatened miscarriage, Delayed miscarriage, Inevitable miscarriage, Incomplete miscarriage
What is threatened miscarriage?
painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
cervical os is closed
complicates up to 25% of all pregnancies
What is delayed miscarriage?
a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear
when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’
What is ineviatble miscarriage?
cervical os is open
heavy bleeding with clots and pain
What is incomplete miscarriage?
Not all products of conception have been expelled
What are 5 causes of abdominal pain in late pregnancy?
Labour, placental abruption, symphysis pubis dysfunction, pre-eclampsia/HELPP syndrome, uterine rupture
What is placental abruption and how frequently does it occur?
Placental abruption describes separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space
Occurs in 1/200 pregnancies
What are clinical features of placental abruption?
shock out of keeping with visible loss
pain constant
tender, tense uterus
normal lie and presentation
fetal heart: absent/distressed
coagulation problems
beware pre-eclampsia, DIC, anuria
BC FNT PS
What is symphysis pubis dysfunction?
Ligament laxity increases in response to hormonal changes of pregnancy
Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs. A waddling gait may be seen
When do uterine ruptures occur and what is an RF?
usually occur during labour but occur in third trimester
RF: Previous caesarean
