Acute Abdomen in pregnancy

Abdominal pain is one of the most common disorders of pregnancy; the problem is on distinguishing pathological from physiological pains. Urgent hospital referral may required.

Causes

• Premature labor or term.
• Pre-eclampsia or HELLP syndrome - epigastric or right upper quadrant pain.
• Placental abruption
• With posterior placenta, pain and shock may be less severe, with pain felt in the back; diagnose by pattern of fetal contractions (excessive and frequent) with fetal heart pattern suggesting hypoxia.
• Uterine rupture: Constant pain, profound shock, fetal distress and vaginal bleeding; usually presents during labor and with history of uterine scar.
• Chorioamnionitis: This usually follows premature rupture of membranes but can occur with membranes intact.
• Acute fatty liver of pregnancy: Presents in the second half of pregnancy with abdominal pain, nausea/vomiting, jaundice, malaise and headache.
• Acute polyhydramnios.
• Rupture of utero-ovarian vessels.
• Severe uterine torsion

Diagnosis

• General examination
• Abdominal examination 

Tests

• Clotting screen: placental abruption or liver disease suspected
• Sickle cell screen;
• Blood film
• Urine test: suspected pre – eclampsia.
• ECG
• Ultrasound

Management

• Opioids : Tramadol
• If surgery is deemed necessary during pregnancy, perform it in second trimester if possible.