ABDOMINAL PAIN IN PREGNENCY

This is a very common symptom in pregnancy whose importance and significance, may vary from simple to very serious one. The practitioner should call on his clinical acumen to diagnose the condition as the cause of pain may me obstetrical, gynaecological, surgical or medical in origin. Systematic history taking, clinical examination and special investigations (like blood, urine, radiological examinations) should tend to find out the following causes :

During first half of pregnancy:

Obstetrical and gynecological causes: Abortion disturbed ectopic gestations (also angular or corneal pregnancy), incarcerated retroverted gravid uterus with acute retention of urine, occasionally incarcerated uterine fibroid in pelvis or rupture of a superficial vein in it or torsion of pedunculated fibroid, twisted ovarian cyst, twisted hydrosalpinx or acute salpingitis. Surgical and medical causes: Pyelonephritis, appendicitis, intestinal obstruction, peptic ulcer, basal pneumonia, and other conditions. In tropics, basal pneumonia, and other conditions. In tropics, colitis, dysenteries, intestinal worms are important causes of abdominal pain.

Abdominal pain during later half of pregnancy:

Obstetrical and gynaecological causes: Concealed accidental haemorrhage, uterine distension pain as in acute dydramnios, pain under the ribs by pressure of head in breech presentation, epigastric pain in severe pre-eclampsia, uterine rupture, red degeneration in uterine fibroid in addition to complications as mentioned during first half of pregnancy, rupture or torsion or pressure pain of ovarian cyst, torsion of the pregnant uterus especially in double uterus, torsion of hydrosalpinx, pain on the round ligament due to stretching or varicocele, broad ligament varicocele, pelvic osteoarthropathy and secondary abdominal pregnancy. In search of cause for pain, the practitioner must exclude the commonest cause of pain for the uterine contractions, i.e. premature onset of labor pain. Surgical and medical conditions: Same causes as in the first half of pregnancy may operate. In addition, volvulus, cholecystitis, gall stone are also the possibilities.