Abdominal Pain with Pregnancy
(A) Pregnancy Related Pain:
(I) First trimester:
1. Abortion: Inevitable, incomplete or septic abortions.
2. Vesicular mole: when expulsion starts.
3. Ectopic pregnancy: pain precedes bleeding.
(II) Second trimester:
1.Mid-trimester abortion: although abortion due to cervical incompetence is relatively painless it may be preceded by mild lower abdominal pain.
2. Angular pregnancy ; or rupture of a rudimentary horn.
3. Red degeneration of fibroids.
4.Stretch of the nerve fibres in the round ligaments: pain in one or both iliac fossae between the 16th and 20th weeks of pregnancy.
(III) Third trimester:
1. Abruptio placentae.
2. Rupture uterus.
3. Severe pre-eclampsia: associated with upper abdominal pain.
4.Pressure symptoms:as engagement of the head , distension of the abdominal wall and pain due to flaring of the ribs particularly in breech presentation.
5.Braxton Hicks contractions: Although it is usually painless, many women find it painful.
6.False labour pain: irregular, not progressively increasing and not associated with bulging of forebag of water or dilatation of the cervix.
7. Labour pain.
(B) Incidental Abdominal Pain:
(I) Genital causes:
1.Acute salpingitis: It is rarely seen because the presence of a pregnancy in the uterus prevents ascending infection and if the disease is chronic infertility is more likely.
2. Complicated ovarian cyst: as torsion, rupture, or haemorrhage.
(II)Gastro-intestinal causes:
1-Hurt burn and hiatus hernia.
2-Peptic ulcer.
3-Biliary diseases.
4-Pancreatitis.
5-Acute appendicitis.
6-Constipation.
7-Acute intestinal obstruction.
8-Inflammatory bowel disease: Crohn’s disease and ulcerative colitis.
(III) Renal causes:
1-Pyelonephritis.
2-Renal calculi.
3-Acute retention of urine.
(IV) Miscellaneous:
1. Vascular accidents: e.g.
– rectus sheath hematoma,
– mesenteric thrombosis, and
– ruptured spleen or splenic aneurysm.
2-Malignant lesions.
3-Porphyria.