Obstetrics: Abdominal Pain

Early Pregnancy

Miscarriage

Ectopic Pregnancy

Any Point in Pregnancy

Late Pregnancy

Symphysis Pubis dysfunction

Pre-eclampsia/ HELLP syndrome

Abruption

Uterine Rupture

Labour

Appendicitis

UTI

1 in 25 women

Associated risks

increased risk of pre-term labour

IUGR

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

3rd: RUQ

2nd: Umbilicus

1st: RLQ

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

Associated with hypertension and proteinuria. HELLP = haemolysis, elevated liver enzymes and low platelet count

pain is typically epigastric or in the RUQ

ligament laxity due to hormones. pain over the PS with radiation to the groins and the medial aspects of the things. waddling gait.

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

regular tightening of the abdomen

Missed (delayed) miscarriage

Inevitable

Threatened

Incomplete

painless vaginal bleeding occuring before 24wks (6-9 wks). cervical os closed. complicates upto 25% of pregnancies

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

no all products have been expelled.

Risk factors

IVF (3%)

previous ectopic

damage to tubes

Typical Hx

vaginal bleeding: usually less than a normal period, dark brown colour.

ammenorrhea (6-8wks)

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