abdominal pain in pregnancy

Question 1

abdominal pain in the first trimester (6)

Answer 1

1. Ectopic pregnancy
2. Hyperemesis gravidarum / morning sickness
3. Hormone related / threatened miscarriage
4. UTI
5. Ovarian cyst

Question 2

medical causes of abdominal pain which are exacerbated in pregnancy

Answer 2

1. constipation
2. GORD
3. Appendicitis
4. Pancreatitis
5. Acute Cholecystitis
6. Fibroids
7. IBD

Question 3

pregnancy specific causes of abdominal pain

Answer 3

1. normal labour
2. pre term labour
3. Obstetric cholestasis
4. Acute fatty liver of pregnancy
5. Pre eclampsia
6. Placental abruption

Question 4

threatened miscarriage

Answer 4

1. common form of abdominal pain in the first trimester
2. 1 in 5 pregnancies before 10 weeks end in miscarriage and this increases as patient > 40
3. abnormal bleeding and abdominal pain that occurs as pregnancies still continues

Question 5

hormone related pains

Answer 5

1. non pregnant uterus needs to stretch and this can cause pain
2. this is known as ‘stretching pains’ / uterine growth

Question 6

Hyperemesis gravidarum (3)

Answer 6

1. nausea and vomiting are normal particularly in the first trimester 50%
2. Hyperemesis is pathological - assoc with
   - significant weight loss - 10-20% of body weight loss
   - dehydration and malnutrition
3. retching and straining of abdo muscle - vomit to tear esophagus and vomit blood (mallory-weiss syndrome)

Question 7

treatment for hyperemesis gravidarum

Answer 7

1. anti-emetics are unhelpful - related to HcG levels, relieved by 14 - 20 weeks
   * * Phenothiazides
   * *Dopamine antagonists - metoclopromide
   * ** Antihistamines -cyclizine
2. Steroid treatment - for women with sig weightloss/helps with appetite
3. Carb malnutrition/loss of vitamin B - Wernicke’s encephalopathy
4. Rehydration and dietetic advice - acidic/fatty food is poorly tolerated

Question 8

UTI

Answer 8

1. common in 7% of early pregnancy
2. Pregnancy - more degree of urinary stasis which can promote bacterial accumulation and infection
3. complicated UTI// 30% develop pyelonephritis
4. 6% have asymptomatic bacteruria which can progress to pyelonephritis
5. dysuria - common in pregnancy

Question 9

treatment for UTI in pregnancy

Answer 9

7 day course of antibiotics

1. cefalexin (may have penicillin allergy)
2. Nitrofurantoin - avoid at term as it can cause haem anaemia in newborn
3. Trimethoprim - avoid in first 20 weeks

Question 10

Constipation

Answer 10

1. exacerbated in pregnancy

2. increase in progesterone causes relaxation of smooth muscle, delayed gastric emptying and decreased motility