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Introduction
Abdominal pain is a very common symptom in pregnant women. It may be due to pregnancy itself e.g red degeneration in a fibroid or may arise from some concomitant lesion such as appendicitis. It is convenient to divide the causes of pain due to pregnancy into those most commonly found in each of the three trimesters,though of course there is considerable overlap.
A 22 yr old para 1 with 6-8 wks gestation presents with abdominal pain.
The History Colicky Pain - Localized one sided pain, no radiation, spasmodic to start with, now constant. Mild bleeding p/v. Some chest pain and shoulder tip pain. Has been feeling faint. Pregnancy test positive.
THINK ECTOPIC
VITAL SIGNS B HCG QUANTITATIVE URGENT PELVIC USS REFER/ADMIT TO HOSPITAL
Mx of Ectopic Pregnancy
Medical with Methotrexate with or without folinic acid. Surgical laparotomy and laparoscopy salpingostomy and salpingiectomy Follow up and prognosis
First Trimester
1. 2. 3. 4. 5. Abortion pregnancy in rudimentary horn Acute salpingitis Acute Retention of urine Hydatidiform mole
Abortion
Pain preceeded by vaginal bleeding. Cervix, closed (threatened abortion)or open (inevitable)..U/S.gestational sac inside uterine cavity.
Acute Salpingitis
May develop up to the 10th.weeks after conception, due to gonococcal infection or infection at attempted attempted abortion Pain felt in both iliac fossae & is continuous There is associated tenderness,tachycardia and elevated temperature,culture of discharge may reveal pathogens
Hydatidiform mole
Pain in lower abdomen. Pain due to
Overdistention of uterus Concealed haemorrhage Perforation Infection Uterine contraction for expulsion
A 22 yr old para 1 with 6-8 wks amenorrhea presents with abdominal pain
The history changes: Crampy lower abdominal Heavy bleeding p/v Speculum examination
cx os closed cx os open
DIAGNOSIS - ? MISCARRIAGE
Assess hemodynamic stability Arrange pelvic ultrasound Management depends on ultrasonographic findings. No role of Bhcgs Blood group, Rhesus and anti-D if necessary
Acute polyhydramnios
Pain is due to over distention. It can be differentiated from. pregnancy by absence of foetal heart sound.
relieved
A History
22 yrs old 1st pregnancy presents with right sided abdominal pain for about 2 days. It starteds with a vague pain in the epigastrium and is now constant on the rt side. She is about 26 wks pregnant and there is no vaginal bleeding. Her 20 wk scan was normal.
APPENDICITIS
Most common cause of acute abdomen in pregnancy Tenderness over McBurneys point. Low grade fever. DD-Rupture ectopic pregnancy,Bilat.salphingoopheritis,Renal colic,Placental abruption,Degn.of uterine myoma.
APPENDCITIS - DIAGNOSIS
Appendix is progressively displaced upwards after 12 wks and reaches iliac crest at 24 wks. Single most reliable symptom in pregnancy is Refferred pain Anorexia, vomiting, rebound , guarding are not specific in pregnancy Leucocytosis is NOT helpful.
APPENDICITIS - DIAGNOSIS
Graded compression ultrasonography accurate in 1st and 2nd trimesters , difficult in 3rd. 98% ACCURATE.
APPENDICITISCONSEQUENCES
High fetal loss rate if perforation occurs (20%) Maternal mortality Mortality of delay Risk of perforation highest in 3rd trimester Premature labour esp in the 1st week after surgery
Acute Pyelonephritis
Site remains the same Aching pain Right costovertebral angle tenderness High grade
Cholecystitis
Right subcostal pain lower border of 9th rib, radiating to back and shoulder. May radiate to chest . Usually severe and lasts only for mins or hrs. Starts at night and wakes the patient.
USG
Acute Pancreatitis
the onset is sudden with severe upper abdominal pain & vomiting.usually serum amylase and urinary diastase levels elevated. Treatment is usually symptomatic.
Doppler
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