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Abdominal pain in pregnancy

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causes and differentials

causes and differentials

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  • 1. ABDOMINAL PAIN INPREGNANCY Associate Professor Dr Hanifullah Khan
  • 2. CAUSES OF ABDOMINAL PAIN DURING PREGNANCY• A. Pregnancy Related Pain: • B.Conditions associated with Early pregnancy pregnancy o Abortion: Inevitable, UTI incomplete or septic Vaginal Infections abortions • C. Non-Pregnancy Related o Vesicular mole: when Pain expulsion starts. • Gastrointestinal o Ectopic pregnancy: pain precedes bleeding. o Acute appendicitis Later pregnancy o Peptic ulcer o Braxton-Hicks Contraction o AGE o Placental abruption HepatoBliary o Pre-eclampsia , HELLP o Biliary Stones o Chorioamnionitis Genitourinary o Labor ( Term , Preterm ) o Ureteral calculus o Acute pyelonephritis o Acute cystitis Other o Abdominal trauma
  • 3. Urinary tract infection• Acute cystitis acute pyelonephritis and urolithiasis• Acute cystitis - occurs in 1-2% of cases -2/3th of cases have cystitis in spite of their sterile urine at bookingExperience urinary symptoms and abdominal discomfort
  • 4. Braxton Hicks contractions∗• Sporadic uterine contractions - actually start at about 6 weeks, – although women wont be able to feel them that early. – Usually noticeable only after midpregnancy,• Increase in frequency as pregnancy progresses – But they remain infrequent, irregular, and essentially painless.• Sometimes, though, hard to distinguish from early signs of preterm labor• May get more intense and more frequent, and cause some discomfort. ∗ John Braxton Hicks, 1872.
  • 5. False labour pain ( Late Braxton Hicks contractions )• Irregular,• Not progressively increasing• Not associated with bulging of forebag of water or dilatation of the cervix.• Respond to anlgesics• Cause women confusion as to whether or not they were going into actual labor.• They are thought to be part of the process of effacement, the thinning and dilation of the cervix
  • 6. Abortion Miscarrage – Common in the first trimester – Vaginal bleeding – Cramp like pain – Dealt with under bleeding in pregnancy
  • 7. Ectopic Pregnancy• Most common obstetric cause of acute abdomen• Pain usually one-sided initially – Can be confused with appendix if on the right• May be sharp initially• Later, may be diffuse and dull• Shoulder tip pain
  • 8. Placental Abruption• Premature separation of the placenta from the uterus, – resulting in bleeding from the site of placental attachment (concealed , revealed . Combined )• The triad of abdominal pain, uterine rigidity, and vaginal bleeding – Suggests abruption – Also fetal tachycardia• A tender uterus is highly suggestive• Prepare for DIC, which complicates 33% -50% of severe cases,• Beware PPH, which is also common
  • 9. Site: Contraction occurs at the uterus Radiating: Pain at uterus, which sometimes radiates to the backOnset: Spontaneously Associated symptoms: Leaking of liquor,Character: Show•Intermittent Time: 20-60 seconds per contraction(comes in an irregular which thenbecomes regular pattern over time withone to several pain-free minutes in Exacerbating factors: -between them)•Increasing in frequency Severity: mild, moderte, severe(Contractions almost always start off mildand gradually grow longer, stronger, andcloser together)•Spasmodic(on and off) HISTORY OF LABOUR•Self-limiting PAIN(rarely takes more than 24 hours)
  • 10. Preterm labour•Definition•Classification of preterm labour•Causes of preterm labour•History and examination findings•Investigations
  • 11. Definition of preterm labor Defined as the presence of uterine contractions of sufficient frequency and intensity to effect progressive effacement and dilation of the cervix prior to term gestation (between 24+0 and 36+6 weeks) http://emedicine.medscape.com/article/260998-overview
  • 12. • Extremely preterm birth: 24+0Classification of to 27+6 weeks (incidence 0.4%)preterm labour • Very preterm birth: 28+0 to 31+6 weeks (incidence 0.7%) • Mildly preterm birth: 32+0 to 36+6 weeks (incidence 5.5%)
  • 13. Extremely Very preterm Mildly preterm preterm 28+0 to 31+6) (32+0 to 36+6)(24+0 to 27+6)
  • 14. Causes of preterm labour• Infections (chorioamnitis)• Over distension (multiple pregnancy, polyhydramnios)• Vascular causes (eclampsia)• Intercurrent illness (pyelonephritis)• Cervical weakness
  • 15. POSSIBLECAUSES
  • 16. History• Ask about age of gestation, history of leaking or bleeding• Pain -cramp-like pain, low backache -radiates to the back -increase in intensity and frequency -spontaneous onset -not relieved by posture/ medications -associate with liquor/show/blood• Pelvic pressure• Increase of vagina discharge• Vaginal bleeding
  • 17. Physical examination• Uterus: tender (abruption/ chorioamnionitis)• Speculum examination revealed: -pooling of amniotic fluid -abnormal discharge/ blood

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