Abdominal pain in pregnancy Flashcards
How can you divide the causes of abdo pain in pregnancy?
- Obstetric
- Surgical
- Medical
What are some surgical causes of abdo pain?
- Acute appendicitis
- Cholecystitis
- Renal colic
- Pancreatitis
- Bowel obstruction
- Ovarian cyst
What are some medical causes of abdo pain?
- Constipation
- UTI
- IBD
- GORD
- Gastroenteritis
- Pyelonephritis
- MI
- DKA
How can you classify obstetric causes of abdo pain by severity & what falls under each of them?
- Benign
1. Braxton Hicks contractions
2. Degenerating fibroids - Serious
1. Pre-term labour
2. Pre-eclampsia/HELLP syndrome
3. Chorioamnionitis - Emergency
1. Placental abruption
2. Uterine rupture
3 key features of Braxton-Hicks contractions
- Do not increase in frequency, duration or intensity
- Do not cause dilation of cervix
- Typically felt in the 2nd or 3rd trimester (more common in late 3rd trimester)
Key features of degenerating fibroids in pregnancy
- Approximately 1/3 of uterine fibroids increase in size during pregnancy
- Enlargement results in the central areas suffering relative ischaemia (red degeneration)
- Pain is constant and localised to the side of the uterus where the fibroid is
How are degenerating fibroids managed?
- Reassurance
- Adequate analgesia (may require admission)
What are the presenting symptoms of pre-term labour?
- Abdominal crampy pain
- Regular tightenings or contractions
- Backache
- Vaginal spotting
All women presenting with symptoms suggestive of pre-term labour MUST…
Have a speculum examination
What are the 3 additional medications needed in pre-term labour?
- Steroids - to promote lung maturation in the fetus (offered to any woman going into labour < 34 weeks)
- IV antibiotics - preterm babies have increased susceptibility to infection
- Magnesium sulphate - neuroprotection
What are 3 common risk factors for pre-term labour?
- Previous preterm labour
- Multiple pregnancy
- Cervical surgery
What are the features of chorioamnionitis?
- Maternal pyrexia
- Maternal tachycardia
- Fetal tachycardia
- Uterine tenderness
- Purulent or foul smelling amniotic fluid
What are the maternal complications that can result from chorioamnionitis?
- Increased need for C section
- Increased risk of endometritis following surgery
- Increased risk of sepsis
- Increased risk of PPH
What are the neonatal complications that can result from chorioamnionitis?
- Early onset sepsis
- Perinatal death
- Cerebral palsy
What is the management of chorioamnionitis?
- IV antibiotics
- Expedite delivery
What is HELLP syndrome?
Haemolysis, Elevated Liver enzymes, Low Platelets
What are the presenting features of placental abruption?
Severe abdominal pain +/- PV bleeding
What are the risk factors for placental abruption?
Hypertensive disorders of pregnancy Preterm labour Premature rupture of membranes Smoking Cocaine abuse
What are the findings on examination in placental abruption?
- Uterus larger than gestation
- Tense and tender (“woody uterus”)
What is the management of placental abruption?
- Immediate delivery
- Anticipate PPH (as higher risk in placental abruption)
What are the 2 biggest risk factors for uterine rupture?
- Previous caesarean section
- Inter-delivery interval of <18-24 months after a caesarean section
What are the presenting features of uterine rupture?
- Sudden tearing pain continuing between contractions
- Vaginal haemorrhage
- Fetal bradycardia
