Abdominal Pain in Pregnancy

There should be no hesitation in the use of ancillary investigations, laparoscopy and even MRI to decipher the possible cause of unexplainable abdominal pain in pregnancy lasting for more than eight hours.

Most cases of abdominal pain during pregnancy are caused by relatively minor conditions like stretching of the supporting uterine ligaments, or even strain on the joints of the pelvis like the pubic symphysis, to Braxton hicks contraction, that may or may not require further treatment than the prescription of simple pain killer like paracetamol.

It is conditions like ectopic pregnancy, acute appendicitis, urinary tract infection, gall bladder disease (cholecystitis or billiary colic), threatened abortion (miscarriage), placenta abruption, perforation of a duodenal ulcer, acute pancreatitis, to name but a few, that requires immediate diagnostic workup and treatment.

• Miscarriage

  Miscarriage is a cause of abdominal pain during early pregnancy, especially in the first trimester of pregnancy, usually up to the twelfth week of pregnancy. It should be suspected if a woman presents with a lower abdominal pain in early pregnancy, cramping in character, like menstrual pain. It is often associated with bleeding from the vagina. This may settle with rest, in which case, the pregnancy may continue successfully, a condition doctors refer to as threatened abortion. Should the bleeding continue and is profuse, the pregnancy is almost certain to be lost. Blood clots may be passed, with some tissue or foetal parts. In this case, it is refereed to as completed abortion. A woman experiencing any of these symptoms should see the doctor for assessment, to exclude a more dangerous condition which can present like this, called ectopic pregnancy.

• Urinary Tract Infection Abdominal Pain in this situation may be associated with increased frequency of urination, pain on passing urine, feeling generally unwell, poor appetite, and a lower abdominal pain around the bikini line. A urine dip stix test may reveal infection in the urine.

• Constipation

  Constipation is a cause of abdominal pain in all age groups and sex, and even more so in the pregnant. There will be reduced frequency of opening one’s bowel. The bowel motion may be hard and constipation leads to pain in the right, but more frequently on the left lower abdomen.

• Heartburns

  Acid reflux after a heavy meal or even following a normal meal can cause some abdominal discomfort. The Sphincter on the lower aesophagus becomes even weaker during pregnancy, coupled with the pushing upward of the bowel and stomach by the rising uterus, makes heartburn more common in the pregnant.

• Gastritis Gastritis is the inflammation of the lining of the wall of the stomach. This can be caused by too much acidity, stress, irritation of the stomach by substances like alcohol or too spicy food, or infection or medications like ibuprofen or diclofenac (drugs referred to as NSAID). It presents as upper central abdominal pain or discomfort, burning or stabbing in nature, and could spread right through the upper abdomen to the back, as if between the shoulder blades. It is another frequent cause of abdominal in pregnancy.
• Hiatus Hernia Hiatus hernia occurs when the stomach escapes from the abdomen into the chest, passing through an abnormal opening in the diaphragm. The stomach may become twisted, or strangulated, causing pain, in the upper abdomen or lower chest. The symptoms may present like gastritis or heart burns, and diagnosis can anly be made after the appropriate investigations.

• Appendicitis Acute appendicitis is the most common non-pregnancy related cause of abdominal pain during pregnancy, accounting for up to 25% of surgical operations in the pregnant for non-obstetric reason. Despite this high incidence of appendicitis in pregnancy, diagnostic difficulties and hesitancy is not uncommon. A high index of suspicion is there for required to help in clinching the common causes of abdominal pain in the pregnant. It presents as lower right abdominal pain in pregnancy. The pain often starts gradually, worsening over a day or two. It will be constant in nature, aggravated by movement. There will be associated loss of appetite, nausea, and patient may even vomit. Depending on the stage of the pregnancy, the site of pain may be low in the right abdomen, or even high, up to just under the right ribs. Any cause of right lower abdominal pain in pregnancy thus needs urgent and thorough investigation.

• Gallbladder Stone or Cholecystitis

  Gall bladder stone disease in pregnancy would present exactly as in the non-pregnant woman. It comes on as pain in the upper right abdomen. It could be cramping in nature, often brought about by the ingestion of fatty meals. There may be associated vomiting. Fever comes in if the inflammation caused by the stone leads to infection, a condition called cholecystitis. Without an infection, gall bladder stone pain is called billiary colic.

• Ectopic Pregnancy

  Ectopic pregnancy is the night mare of every woman of child bearing age who are sexually active. This is pregnancy occurring outside the uterus. The fetus could be implanted along the narrow fallopian tube, in the ovary, on the supporting uterine ligament, or in the open abdominal cavity! As the fetus grows in this unnatural site, this could lead to the rupture of the enclosing structure like in the narrow fallopian tube, or grow into a blood vessel, leading to massive internal bleeding. Ectopic pregnancy often occurs within the first six to ten weeks of pregnancy – just when these mothers to be realizes that they have lost a period, and perhaps wondering what might be going on. The fact that most women who have ectopic pregnancy do not even realize that they are pregnant makes this condition more of a shock, as well as diagnostic dilemma for an unsuspecting physician.

  Ectopic pregnancy presents with gradual or sudden onset lower abdominal pain, which could be on the right or left side of the lower abdomen. The pain will be continuous, nagging. There may be the realization of having missed one’s menstruation or period by a few days or weeks. There may be associated slight to heavy vaginal bleed. In severe cases, the woman may become dizzy, feeling faint, and weak. There may be shoulder tip pain, especially on lying down.

  If bleeding progresses, there may be sudden onset abdominal bloating and distension, and collapse on standing up to walk. It is an obstetric emergency. Appendicitis, miscarriage and ruptured ovarian cyst in pregnancy could mimic ectopic pregnancy.

• Braxton Hicks Contraction

  Braxton Hicks contractions cause a generalized cramping abdominal pain in pregnancy. These false labor pains usually become more noticeable after the fourth month of gestation. It is the uterus just "practicing for labor".

• Fibroid Agonizing lower abdominal pain in pregnancy can be caused by the presence of uterine fibroid. Fibroid are an abnormal growth of the muscle of the uterus, often budding out and out growing its blood supply. They are more common in the Afro-Caribbean woman, but also in woman of any race. They presents as abdominal cramps in pregnancy. The pointer to the presence of fibroid in pregnancy, for a woman who does not know of their existence, is a womb size, well bigger than that expected for that age of pregnancy, with associated cramping abdominal pain.

  Other causes of abdominal pain in pregnancy include:

• Placenta Previa
• Abruptio Placenta
• Labour Pain
• Rectus Sheath Haematoma
• Diabetis Keto Acidosis in Pregnancy
• Ovarian Tumours
• Kidney Stones
• Kidney infection
• Gestational trophoblastic disease
• Pre-eclampsia of Pregnancy
• Polyhydramnios
• Pancreatitis
• Peptic Ulcer Disease

You can read more on specific causes of:

• abdominal pain in early pregnancy

• abdominal pain in late pregnancy

• left abdominal pain during pregnancy

• right abdominal pain during pregnancy

• upper abdominal pain in pregnancy

• lower abdominal pain in pregnancy













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