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UPDATES IN WOMENS’ HEALTH
Acute abdomen in Pregnancy, cont…
Part 2
Adnexal pathology
Ovarian pathology
Haemorrhage into Corpus Lutium conservative management
Ruptured ovarian cyst: conservative management if they are stable
Ovary torsion, (esp. if cyst is present commoner in pregnancy 22.7% vs. 6.1% non
pregnant)
Sudden onset of severe pain
Radiation to flank or anterior thigh
Ultrasound and Doppler flow assist in diagnosis
Uterine Rupture
Trauma: Motor Vehicle Accident
Intra partum: esp. previous classical C section
Fibroids
Red degeneration
Torsion of pedunculated fibroid
Abruptio Placentae
Signs & Symptoms may include: acute abdominal pain, PV bleeding, rigidity, Abnormal
fetal heart rate,
Association:
PET & Hypertension
IUGR
Past history
Idiopathic
Smoking
Drug use
Acute fatty liver of pregnancy
Incidence 1:10000
3rd trimester or postpartum
N/V, Jaundice and abdominal pain, Hypertension and PET(50%)
Abnormal sugars and renal impairment, DIC
High mortality 75-90%
Early recognition & Immediate delivery (72% survival)
Correct fluid, electrolyte and coagulation abnormality
Preterm labour
Defined as regular uterine contractions leading to cervical softening, effacement
and dilatation before 36 completed weeks of gestation.
Signs & symptoms may be capricious. Commonly present with intermittent
abdominal pain, vagianal bleed/discharge or history of spontaneous rupture
of membranes
There may be different causes for threaten premature labour.
As briefly demonstrated, there may be different aetiology for abdominal pains in pregnancy. However the
physician should be vigilant in their diagnosis and liberal in utilizing Obstetrics and surgical expertise in hand.
References
1/“Appendicitis in pregnancy: diagnosis, management and complications”, Anderson, et al: Acta
Obstet Gynecol scand, vol 78(9). Oct 1999. 758-762.
2/“Acute abdomen and the Obstetrician” Sivanesaratnam: Best Prac Res clini obstet gynecol. 14(1):89102, 2000 Feb.
3/“appendicitis in pregnancy: new information that contradicts long-held clinical beliefs”, Mourad et
al: am J Obstet Gynecol, 182(5) May 2000.1027-1029.
4/“Abdominal pain during pregnancy”, Mayer: Gastero Clini Nth Am, 27(1):1-36,1998 Mar
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