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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.

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