Abdominal Pain in Early Pregnancy

Abdominal Pain in early pregnancy brings fear and uncertainty to every expectant mother. Am I about to loose my precious pregnancy? Not necessarily. A miscarriage is just one of the causes of abdominal pains in early pregnancy. Your pain might just be due to the other causes listed here.

Early pregnancy is defined here as the period from conception to the end of the first 12 weeks (three months) of pregnancy. This is also referred to as the first trimester.

Common causes of abdominal pain in early pregnancy include:

  • Miscarriage

  • Ectopic Pregnancy

  • Urinary Tract Infection

  • Acute Appendicitis

  • Severe Constipation

  • Pyelonephritis (kidney infection)

  • Gallstone or Cholecystitis

  • Ovarian Hyperstimulation Syndrome

Other possible causes include gastritis, heartburn, hiatus hernia, pancreatitis, kidney stone, a retroverted uterus that fails to correct itself, and ovarian problems.

Abdominal pain in this stage of pregnancy should be investigated as would be done in the non-pregnant woman. Simple test like full blood count (CBC), electrolyte and urea (BUN, a urine dip stix, and pelvic ultrasound scan where available should be able to provide adequate information and help to exclude the more dangerous causes of pain in the abdomen in early pregnancy.

Abdominal radiography (abdominal X-ray)should be avoided in early pregnancy where possible. A 5 rad exposure in early pregnancy would increase the chances of an unborn child to develop childhood cancer like leukemia five (5) times if the mother where not so exposed. However, it must be said that if the advantage of having an X-ray or indeed a CT scan surpasses the presumed disadvantage, then one should lean towards having the test carried out. Suspected pneumonia, pneumothorax, perforated abdominal viscus, and bowel obstruction are common reasons for x-ray in the pregnant.

  • Miscarriage

    Miscarriage, also called abortion is very common in the first twelve weeks of pregnancy. It often presents as lower abdominal cramp, often like a period or menstrual pain. This pain is almost always preceded by vaginal bleed. A lower abdominal pain in early pregnancy followed by a vaginal bleed is a ruptured or leaking ectopic pregnancy until proven otherwise. It is a gynecological emergency. It accounts for 9 percent of all maternal deaths.

  • Ectopic Pregnancy

    Ectopic pregnancy occurs when the fertilized ovum or foetus gets implanted anywhere else outside the womb or uterus. It is more commonly implanted in the fallopian tubes or ovary. As the foetus grows, it stretches the wall of the containing structure, ruptures it, or even corrodes into a blood vessel, causing a leak or massive blood loss.

    It is a life threatening condition.

    Ectopic pregnancy is a common cause of lower abdominal pain in pregnancy. As much as 2 out of every 100 pregnancy end up as ectopic pregnancy. It presents as pain insidious onset, sometimes as sudden pain, and this is then followed by vaginal bleed. There may be a shoulder tip pain as well as dizziness. If the bleed is completely internalized, the expectant mother may not actually bleed outside.

    Because many women with ectopic pregnancy do not seem to know that they are even pregnant, any cause of severe lower abdominal pain in a woman of childbearing age will require a urine pregnancy test done, to exclude pregnancy and ectopic pregnancy.

  • Appendicitis in Pregnancy

    Appendicitis in pregnancy occurs with equal frequency at all stages of pregnancy. In early pregnancy, appendicitis presents as a right lower abdominal pain. This pain might have started around the umbilicus and then move over and remained in the right lower abdomen. There would be associated nausea, loss of appetite and vomiting.

    Fever is not a frequent presentation of appendicitis in pregnancy. A positive Adler sign (in appendicitis, the point of tenderness remains in the right lower abdominal quadrant even if the patient rolls over onto her left side. If the point of tenderness moves centrally or away from the right iliac fossa, then it is most likely that the tubes or uterus is the site of inflammation or pathology, and Adler sign is said to be positive) makes a diagnosis of appendicitis unlikely.

    That the risk of foetal loss is greatest in the first trimester (early pregnancy), careful investigation to exclude other mimickers of appendicitis is important.

    Appendicitis must be differentiated from ectopic pregnancy by doing an urgent ultrasound scan, and where necessary, a spiral CT abdomen. Pyelonephritis or severe UTI (urinary tract infection) can present like appendicitis too. A simple urine dip stix test and renal ultrasound scan will shed more light on this.

    A diagnosis of appendicitis must not be delayed. Prompt surgical intervention irrespective of the stage of pregnancy ensures optimal outcome for both mother and fetus. Read more on appendicitis in pregnancy here.

  • Rupture or Torsion of an Ovarian Cyst

    Torsion of an ovarian cyst upon its pedicle or a rupture of an ovarian cyst can occur in pregnancy. This will cause abdominal pain in early pregnancy, should it occur within the first twelve weeks of pregnancy.

    The pain will presents as a sudden onset severe right or left lower abdominal pain in early pregnancy. There may be associated sweating, nausea and maybe, vomiting. Adler sign (see above) will be positive. An urgent ultrasound scan will help in clinching the diagnosis.

  • Urinary Tract Infection

    Urinary tract infection is another common cause of abdominal pain in early pregnancy. UTI can occur at any stage of pregnancy, but is commoner in late pregnancy. Apart from the sensation of a lower abdominal pain in early pregnancy, there may be associated increased frequency of passing urine, feeling generally unwell and sometimes, pain in the urethra on passing urine (my urine stings).

    A simple home urinary tract infection tests will demonstrate UTI in most cases.

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