Abdominal Pain in Pregnancy

Question 1

What is the differential diagnosis for abdo pain in pregnancy <24 weeks?

Answer 1

1. Ectopic pregnancy
2. Miscarriage
3. Molar pregnancy
4. Round ligament pain
5. Constipation/urinary retention

Question 2

What is the differential diagnosis for abdo pain in pregnancy >24 weeks?

Answer 2

1. Labour
2. Placental abruption
3. Uterine rupture
4. HELLP syndrome
5. Pubic symphysis dysfunction

Question 3

What are the medical causes of abdo pain in pregnancy?

Answer 3

1. Constipation
2. IBD
3. Gastroenteritis
4. Pyelonephritis
5. UTI

Question 4

What are the surgical causes of abdo pain in pregnancy?

Answer 4

1. Appendicitis
2. Biliary colic
3. Cholecystitis
4. Renal colic
5. Ovarian torsion/fibroids

Question 5

How to patients with an ectopic pregnancy present?

Answer 5

Unilateral lower abdo pain, right shoulder tip pain

Question 6

What does shoulder tip pain indicate?

Answer 6

Haemoperitonium (ruptured ectopic)

Question 7

What is the gold standard investigation for ectopic pregnancy?

Answer 7

Diagnostic laparoscopy

Question 8

How is constipation treated in pregnancy?

Answer 8

High fibre diet, osmotic laxative, glycerine suppositories

Question 9

How is round ligament pain managed in pregnancy?

Answer 9

Reassurance, analgesia, support belt

Question 10

What are Braxton-Hicks and how are they investigated?

Answer 10

Benign uterine contractions
- Vaginal exam, FFT, Amnisure, urinalysis (rule out infection)

Question 11

What causes waddling gait in the third trimester?

Answer 11

Pubic symphysis dysfunction

Question 12

What are the severe causes of abdominal pain in the third trimester?

Answer 12

Placental abruption
Uterine rupture
HELLP syndrome