Abdominal pain in pregnancy

Question 1

How can you divide the causes of abdo pain in pregnancy?

Answer 1

• Obstetric
• Surgical
• Medical

Question 2

What are some surgical causes of abdo pain?

Answer 2

• Acute appendicitis
• Cholecystitis
• Renal colic
• Pancreatitis
• Bowel obstruction
• Ovarian cyst

Question 3

What are some medical causes of abdo pain?

Answer 3

• Constipation
• UTI
• IBD
• GORD
• Gastroenteritis
• Pyelonephritis
• MI
• DKA

Question 4

How can you classify obstetric causes of abdo pain by severity & what falls under each of them?

Answer 4

• 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

Question 5

3 key features of Braxton-Hicks contractions

Answer 5

• 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)

Question 6

Key features of degenerating fibroids in pregnancy

Answer 6

• 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

Question 7

How are degenerating fibroids managed?

Answer 7

• Reassurance

- Adequate analgesia (may require admission)

Question 8

What are the presenting symptoms of pre-term labour?

Answer 8

• Abdominal crampy pain
• Regular tightenings or contractions
• Backache
• Vaginal spotting

Question 9

All women presenting with symptoms suggestive of pre-term labour MUST…

Answer 9

Have a speculum examination

Question 10

What are the 3 additional medications needed in pre-term labour?

Answer 10

1. Steroids - to promote lung maturation in the fetus (offered to any woman going into labour < 34 weeks)
2. IV antibiotics - preterm babies have increased susceptibility to infection
3. Magnesium sulphate - neuroprotection

Question 11

What are 3 common risk factors for pre-term labour?

Answer 11

• Previous preterm labour
• Multiple pregnancy
• Cervical surgery

Question 12

What are the features of chorioamnionitis?

Answer 12

• Maternal pyrexia
• Maternal tachycardia
• Fetal tachycardia
• Uterine tenderness
• Purulent or foul smelling amniotic fluid

Question 13

What are the maternal complications that can result from chorioamnionitis?

Answer 13

• Increased need for C section
• Increased risk of endometritis following surgery
• Increased risk of sepsis
• Increased risk of PPH

Question 14

What are the neonatal complications that can result from chorioamnionitis?

Answer 14

• Early onset sepsis
• Perinatal death
• Cerebral palsy

Question 15

What is the management of chorioamnionitis?

Answer 15

• IV antibiotics

- Expedite delivery

Question 16

What is HELLP syndrome?

Answer 16

Haemolysis, Elevated Liver enzymes, Low Platelets

Question 17

What are the presenting features of placental abruption?

Answer 17

Severe abdominal pain +/- PV bleeding

Question 18

What are the risk factors for placental abruption?

Answer 18

Hypertensive disorders of pregnancy
Preterm labour
Premature rupture of membranes
Smoking
Cocaine abuse

Question 19

What are the findings on examination in placental abruption?

Answer 19

• Uterus larger than gestation

- Tense and tender (“woody uterus”)

Question 20

What is the management of placental abruption?

Answer 20

• Immediate delivery

- Anticipate PPH (as higher risk in placental abruption)

Question 21

What are the 2 biggest risk factors for uterine rupture?

Answer 21

• Previous caesarean section

- Inter-delivery interval of <18-24 months after a caesarean section

Question 22

What are the presenting features of uterine rupture?

Answer 22

• Sudden tearing pain continuing between contractions
• Vaginal haemorrhage
• Fetal bradycardia