Abdominal Pain in Pregnancy Challenges Differentials are broad

Abdominal Pain in Pregnancy Challenges: • • Differentials are broad- must include pregnancy-related and unrelated causes Physical exam changes as uterus expands and displaces abdominal organs Pregnancy related causes of acute abdominal pain First Half of Pregnancy Ectopic pregnancy Anytime Fibroid degeneration or torsion Miscarriage Ovarian cyst hemorrhage Constipation Second Half of Pregnancy Placental abruption Pre. E/HELLP Acute fatty liver of pregnancy Uterine rupture Normal labor Intraamniotic infection Fetal movement or position Round ligament pain Postpartum Group A strep infection Urinary retention Red Flags Associated symptoms of nausea, vomiting, vaginal bleeding, headache or fever Peritoneal signs are never normal during pregnancy! Endometritis Wound complications Normal uterine involution Updated 4/20

Abdominal Pain in Pregnancy Differentials must include all med-surg non-pregnancy related causes as well Upper Abdominal Pain GERD Lower Abdominal Pain Gallbladder disease including acute cholecystitis Appendicitis- pain may be anywhere due to displacement from uterus Pneumonia Nephrolithiasis Bowel obstruction Pelvic infections and PID (extremely unusual in pregnancy) Hepatitis Pancreatic disease Peptic ulcers Ovarian torsion Inflammatory bowel Imaging studies Typically use ultrasound first MRI usually preferred over CT to avoid radiation Gadolinium crosses placenta, so MRIs should usually be noncontrast Order the best study to address your clinical concern! Delays in diagnosis harm moms and babies Discuss ways to reduce fetal exposure with radiology