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Abdominal Pain During Pregnancy?

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... the picture of acute abdomen may develop with shock. First Trimester Pain ... Torsion of ovarian cyst may occur especially during first trimester. ... – PowerPoint PPT presentation

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Title: Abdominal Pain During Pregnancy?


1
Abdominal Pain During Pregnancy?
  • Dr.Samir Fouad AbdelAziz
  • Assit.Professor Ob.Gyn.
  • Al-Azhar University

2
  • Abdominal pain is a very common symptom in
    pregnant women. It may be due to pregnancy itself
    e.g red degeneration in a fibroid or may arise
    from some concomitant lesion such as
    appendicitis.
  • It is convenient to divide the causes of pain due
    to pregnancy into those most commonly found in
    each of the three trimesters,though of course
    there is considerable overlap

3
First Trimester
  • Abortion
  • Disturbed Ectopic pregnancy
  • pregnancy in rudimentary horn
  • Acute salpingitis
  • Acute Retention of urine

4
First Trimester pain
  • Abortion
  • Pain preceeded by vaginal bleeding,
  • in the middle intermittent.
  • Cervix,closed(threatened abortion)or open
    (inevitable)..U/S.gestational sac inside uterine
    cavity.

5
First Trimester Pain
  • Ectopic pregnancy
  • Pain typically occur before bleeding and blood
    tend to be dark(prune juice)
  • Pain tends to be limited initially to the
    affected side,though if interperitoneal bleeding
    occurs it become generalised the picture of
    acute abdomen may develop with shock

6
First Trimester Pain
  • Pregnancy in rudimentary horn
  • pain resemble that of ectopic and usually the
    condition discovered during laparotomy
  • If rupture occurs it usually in the midtrimester
    and of sudden onset with collapse

7
First Trimester Pain
  • Acute Salpingitis
  • May develop up to the 10th.weeks after
    conception,due to gonococcal infection or
    infection at attempted attempted abortion
  • Pain felt in both iliac fossae is continuous
  • There is associated tenderness,tachycardia and
    elevated temperature,culture of discharge may
    reveal pathogens

8
First Trimester Pain
  • Acute retention of urine
  • is usually due to enlargement of a cervical
    fibroid in response to pregnancy and may occur
    very early
  • Severe lower abdominal wall, large tender bladder
    which may be mistaken for ov. Cyst
  • Catheterisation causes immediate relief of pain

9
Midtrimester Pain
  • Acute retention of urine due to incarcerated RVF
    gravid uterus
  • Red degeneration in a fibromyoma
  • Rupture of rudimentary horn containing pregnancy
  • Stretching of round ligament
  • Abortion

10
Midtrimester Pain
  • Red degeneration of fibromyoma
  • causes pain ranging from mild to severe over the
    fibroid.tenderness usually present over the
    fibroid.
  • U/S usually detect the fibroid during first
    trimester
  • There may be history of menorrhagia before
    pregnancy..TT..conservative with analgesic

11
Midtrimester Pain
  • Stretching of the round ligament may sometimes be
    a cause of mid-trimester pain
  • Usually pain is continuous and there is
    tenderness over the affected ligament
  • There is no constitutional symptoms.
  • Reassurance and sometimes mild analgesia is
    required

12
Third Trimester Pain
  • Concealed haemorrhage
  • Severe preeclampsia
  • Red degeneration of fibromyoma
  • Uterine rupture
  • Contractions of labour

13
Third Trimester Pain
  • Concealed haemorrhage
  • Pain is of acute onset is severe, with
    considerable shock and collapse.
  • The abdominal ms. Are tense and the uterus may be
    larger than expected, hard tender with difficulty
    in palpating fetal parts
  • Fetal heart is usually absent
  • there may be vagina bleeding
  • There may be hypertension before the event

14
Third Trimester Pain
  • Severe Pre-eclampsia
  • Epigastric pain may occur is a sign of
    impending eclampsia.
  • The characteristic signs of pre-eclampsia,
    hypertension, proteinuria and oedema are present
  • The uterus is not tender fetal parts are
    palpable FHR usually present

15
Third Trimester Pain
  • Uterine rupture is a possibility in highly
    parous women those who have scarred uterus by
    CS,Myomectomy or perforation.
  • Women usually feel a tearing sensation followed
    by constant pain..shock collapse. Vaginal
    bleeding is common.
  • Fetal parts easily felt FHR is absent

16
Third Trimester Pain
  • Labour pains
  • may occur prematurely or at term, they are
    intermittent gradually become stronger and more
    frequent.
  • The characteristic show of early labour will be
    observed and on vaginal examination cervix will
    be taken up and perhaps dilated

17
Incidental Causes of Pain
  • Gastro-enteritis
  • Pain is generalised over the abdomen and
    accompained by vomiting and diarrhoea.
  • Temperature is elevated and abdomen is tender
    with no rigidity
  • stool analysis show organism

18
Incidental causes of Pain
  • Acute Appendicitis and Pyelonephritis
  • the appendix is displaced upward and laterally as
    pregnancy advances and its tip overly the tip of
    right kidney. Appendicitis may be confused with
    pyelonephritis

19
  • In pyelonephritis the pain is often of an aching
    character and felt only in the lumbar region,
    however, it may be felt only in the right side of
    abdomen in severe cases may be diffused over
    the whole abdomen
  • in pyelonephritis the tenderness is usually
    localised in the right costovertebral angle

20
  • In pyelonephritis temperature tend to be high
    and pulse rate in relation to temperature tend to
    be lower than in case of appendecitis
  • Even with sever cases the tongue is usually
    moist in cases of pyelonephritis,but usually dry
    with appendicitis.
  • In case of doubt laparotomy is indicated, to
    avoid mortality with appendicitis

21
Incidental causes(cont.)
  • Renal and uretric calculi
  • Pain may be confused as pyelitis and radiate to
    leg. Blood may be present in the urine and U/S
    may show stone in kidney or bladder.
  • Acute cholycystitis..usually positive history
    present and pain over Rt.hypochondrium, radiate
    to Rt.shoulder.U/S may show stone in G.B

22
Incidental causes of Pain
  • Perforation of a hollow organ
  • such as the stomach or duodenum, may occur with
    sudden pain, collapse and the rapid development
    of generalised peritonitis
  • Usually history of peptic ulcer or gastric ulcer
    is present

23
Incidental Causes of Pain
  • Strangulated hernia should be born in mind and
    hernial sites should be examined
  • Acute Pancreatitis the onset is sudden with
    severe upper abdominal pain vomiting.usually
    serum amylase and urinary diastase levels
    elevated.
  • Treatment is usually conservative

24
Incidental causes(cont.)
  • Acute Hepatitis
  • May occur in hyperemesis gravidarum, in sever
    pre-eclampsia/eclampsia or in acute infective
    hepatitis. In all these conditions there is pain
    tenderness over the liver jandice is usually
    soon manifest

25
Incidental Causes (cont.)
  • Acute intestinal obstruction
  • Sometimes found in pregnancy usually there is
    history of laparotomy if there is band of
    adhesion the enlarged uterus displaces the
    intestine obstruction occurs.The onset is
    usually sudden,with vomiting. Distention
    vomiting with colicky pains are typical.

26
Incidental Causes(cont.)
  • Torsion of ovarian cyst may occur especially
    during first trimester. Pain is at first referred
    to one or other hypochondrium is acute in onset
    usually with vomiting.
  • as peritonitis occur there is pain, tenderness
    rigidity over the tumor.there may be some
    pyrexia.
  • U/S show the cyst

27
Incidental Causes(cont.)
  • Other causes
  • Acute porphyeria
  • Sickling crisis
  • Diabetic ketoacidosis
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