Abdominal pain in pregnancy

Question 1

what is the most important cause you need to r/o in early pregnancy

Answer 1

ectopic

Question 2

risk factors

Answer 2

damage to tubes (salpingitis, surgery)
previous ectopic
IVF (3% of pregnancies are ectopic)

Question 3

typical ectopic history

Answer 3

A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding

Question 4

symptoms

Answer 4

lower abdominal pain

vaginal bleeding

history of recent amenorrhoea

peritoneal bleeding

Question 5

what is usually the 1st symptom?

Answer 5

lower abdominal pain

Question 6

what is the character of the lower abdominal pain?

Answer 6

pain is constant and unilateral

due to tubal spasm

Question 7

what is the vaginal bleeding like during

Answer 7

usually less than normal period

maybe dark brown

Question 8

what can peritoneal bleeding cause?

Answer 8

shoulder tip pain

pain on defecation/urination

Question 9

when does a threatened miscarriage occur?

Answer 9

before 24 weeks

typically 6-9 weeks

Question 10

what happens to cervical os in a threatened miscarriage?

Answer 10

cervical os is closed

Question 11

what is a missed (delayed) miscarriage?

Answer 11

a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion

Question 12

is there any vaginal bleeding/discharge with a missed/delayed miscarriage?

Answer 12

light vaginal bleeding / discharge and the symptoms of pregnancy which disappear

Question 13

what is a blighted ovum or an embryonic pregnancy?

Answer 13

gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes

Question 14

what happens to the cervical os in an inevitable miscarriage?

Answer 14

open

Question 15

what is the bleeding like in an inevitable miscarriage?

Answer 15

heavy bleeding and clots

Question 16

what is the pain like in an inevitable miscarriage?

Answer 16

a lot of pain

Question 17

what is an incomplete miscarriage?

Answer 17

not all products of conception have been expelled

Question 18

what is placental abruption?

Answer 18

separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

Question 19

what is the pain like in placental abruption?

Answer 19

constant

tender

tense uterus

Question 20

what is the foetal heart like in placental abruption?

Answer 20

absent/distressed

Question 21

other features of placental abruption?

Answer 21

shock

normal lie and presentation

coagulation problems

pre-eclampsia, dic, anuria

Question 22

what is symphysis pubis dysfunction?

Answer 22

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.

Question 23

what gait is seen in symphysis pubis dysfunction?

Answer 23

waddling gait

Question 24

what is pre-eclampsia/HELLP syndrome associated with?

Answer 24

hypertension

proteinuria

Question 25

what other features do patients with HELPP have?

Answer 25

haemolysis

elevated liver enzymes

low platelet count

Question 26

where does the pain occur in pre-eclampsia/HELLP?

Answer 26

RUQ/ epigastric

Question 27

When does a uterine rupture usually occur?

Answer 27

during labour but occur in third trimester

Question 28

risk factors to uterine rupture?

Answer 28

previous caesarean section

Question 29

presentation of uterine rupture

Answer 29

maternal shock, abdominal pain and vaginal bleeding to varying degree

Question 30

location of pain in appendicitis during pregnancy

Answer 30

moving up from the RLQ in the first trimester

to the umbilicus in the second

the RUQ in the third

Question 31

what is a UTI in pregnancy associated with

Answer 31

increased risk of pre-term delivery and IUGR