Abdominal_pain_in_pregnancy_flashcards
How can abdominal pain in pregnancy be categorized?
Early, late, or at any point during pregnancy.
What is the most important cause of abdominal pain to exclude in early pregnancy?
Ectopic pregnancy.
What percentage of all pregnancies are ectopic?
0.5%.
What are the risk factors for ectopic pregnancy?
Damage to tubes (salpingitis, surgery), previous ectopic, IVF.
Describe a typical history for ectopic pregnancy.
A history of 6-8 weeks amenorrhoea with lower abdominal pain and later vaginal bleeding.
What are the symptoms of ectopic pregnancy?
Lower abdominal pain (constant, unilateral) and vaginal bleeding (less than normal period, may be dark brown).
What can peritoneal bleeding cause in ectopic pregnancy?
Shoulder tip pain and pain on defecation/urination.
What is a threatened miscarriage?
Painless vaginal bleeding before 24 weeks, typically at 6-9 weeks, with a closed cervical os.
What is a missed (delayed) miscarriage?
A gestational sac containing a dead fetus before 20 weeks without symptoms of expulsion, sometimes described as ‘blighted ovum’ or ‘anembryonic pregnancy’.
What is an inevitable miscarriage?
Open cervical os with heavy bleeding and pain.
What is an incomplete miscarriage?
Not all products of conception have been expelled.
What is a common cause of abdominal pain in late pregnancy?
Labour.
What is placental abruption?
Separation of a normally sited placenta from the uterine wall, causing maternal hemorrhage.
What are the clinical features of placental abruption?
Shock out of keeping with visible loss, constant pain, tender and tense uterus, normal lie and presentation, fetal heart absent/distressed, coagulation problems.
What is symphysis pubis dysfunction?
Ligament laxity causing pain over the pubic symphysis with radiation to the groins and medial thighs, and a waddling gait.
What are the features of pre-eclampsia/HELLP syndrome?
Hypertension, proteinuria, and in HELLP syndrome, haemolysis, elevated liver enzymes, and low platelet count. Pain is typically epigastric or in the RUQ.
When do uterine ruptures typically occur?
During labour, but can occur in the third trimester.
What are the risk factors for uterine rupture?
Previous cesarean section.
What is the most common non-obstetric surgical emergency in pregnancy?
Appendicitis.
What is the occurrence rate of appendicitis in pregnancy?
1:1,000-2:1,000 pregnancies.
How does the location of pain in appendicitis change during pregnancy?
Moves from the RLQ in the first trimester to the umbilicus in the second and the RUQ in the third.
What is the occurrence rate of urinary tract infection (UTI) in pregnancy?
1 in 25 women.
What are the risks associated with UTI in pregnancy?
Increased risk of pre-term delivery and intrauterine growth restriction (IUGR).
