Abdominal pain in pregnancy: Difference between revisions
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*Also consider beta hCG and pelvic US if concerned for spontaneous abortion | *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 | **Consider pelvic exam to check for open cervical os, protruding products of conception | ||
*Urinalysis | *[[Urinalysis]] | ||
*CBC, CMP, lipase, abdominal imaging depending on the differential | *CBC, CMP, lipase, abdominal imaging depending on the differential | ||
Revision as of 23:10, 20 October 2018
Background
- Pregnant women are at risk for the same Abdominal Pathologies causing pain in all patients but also a few special issues.
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
Management
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