Abdominal pain in pregnancy

Background

Estimated gestational age based on physical exam.

• Pregnant women are at risk for the same general abdominal pathologies in addition to unique complications associated with pregnancy

Clinical Features

• Abdominal pain in patient with positive pregnancy test

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

• Ectopic pregnancy
• First trimester abortion
  • Complete abortion
  • Threatened abortion
  • Inevitable abortion
  • Incomplete abortion
  • Missed abortion
  • Septic abortion
• Round ligament stretching
• Incarcerated uterus
• Malposition of the uterus

>20 Weeks

• Labor/Preterm labor
• Placental abruption
• Placenta previa
• Vasa previa
• Uterine rupture
• Vaginal trauma
• HELLP syndrome
• Cholestasis of pregnancy
• Chorioamnionitis
• Incarcerated uterus
• Acute fatty liver of pregnancy
• Malposition of the uterus
• Placenta accreta
• Placenta increta
• Placenta percreta

Any time

• Hemorrhagic ovarian cyst
• Fibroid degeneration or torsion
• Ovarian torsion
• Constipation

Evaluation

• Must consider ectopic pregnancy in pregnant patient presenting with abdominal pain and no documented IUP
  • Quantitative beta hCG and pelvic US
• Also consider beta hCG and pelvic US if concerned for spontaneous abortion
  • Consider pelvic exam to check for open cervical os, protruding products of conception
• Urinalysis
• CBC, CMP, lipase, abdominal imaging depending on the differential

Disposition

Admit

• Ruptured ectopic pregnancy
• Active labor
• Preeclampsia/HELLP
• Placental abruption
• Uterine rupture
• Ovarian torsion
• Surgical abdomen

Discharge

• Ectopic pregnancy if hemodynamically stable with OB follow-up
• Spontaneous abortion if hemodynamically stable with adequate pain control

See Also

• Abdominal Pain
• Pregnancy (main)