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.
- 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
- General examination
- Abdominal examination
- Clotting screen: placental abruption or liver disease suspected
- Sickle cell screen;
- Blood film
- Urine test: suspected pre – eclampsia.
- Opioids : Tramadol
- If surgery is deemed necessary during pregnancy, perform it in second trimester if possible.