Obstetrics: Abdominal Pain (Late Pregnancy (Abruption (Placental abruption…
Obstetrics: Abdominal Pain
damage to tubes
vaginal bleeding: usually less than a normal period, dark brown colour.
lower abdo pain may be first sympton. pain is usually constant and may be unilateral. due to tubal spasm
Peritoneal bleeding can cause shoulder tip pain and pain of defecation/urination
6-8 wks of amenorrhoea, lower abdo pain and later vag bleeding
Missed (delayed) miscarriage
a gestational sac which contain a dead fetus before 20W without the symptoms of expulsion. may have light vag bleeding. symptoms of preg disappear. sac >25mm and no embryonic/fetal part can be seen it is sometimes described as "blighted ovum" or "anembryonic pregnancy"
Cervical os is open. heavy bleeding, lots of clots
painless vaginal bleeding occuring before 24wks (6-9 wks). cervical os closed. complicates upto 25% of pregnancies
no all products have been expelled.
Any Point in Pregnancy
occurs in 1:1,000 pregnancies. most common non-obs durgical emergency
has higher morbidity and mortality in pregnancy
Pain location changes depending on what stage of pregnancy
1 in 25 women
increased risk of pre-term labour
Symphysis Pubis dysfunction
ligament laxity due to hormones. pain over the PS with radiation to the groins and the medial aspects of the things. waddling gait.
Pre-eclampsia/ HELLP syndrome
Associated with hypertension and proteinuria. HELLP = haemolysis, elevated liver enzymes and low platelet count
pain is typically epigastric or in the RUQ
Placental abruption describes seperation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space.
occurs in approx 1 in 200 preg.
Features: shock out of keeping with loss, pain is constant, tender and tense uterus. normal lie and presentaton. fetal heart is absent/distressed/ coagulation problems. beware pre-eclampsia, DIC and anuria
Ruptures usually occur in labour or in 3rd trimesters
Risk factors: prev C Section
Presents: maternal shock, abdominal pain and vaginal bleeding to a varying degree
regular tightening of the abdomen