Ectopic Pregnancy

Approach to abdominal pain and the acute abdomen in pregnant and postpartum women

Charlie C Kilpatrick, MDAssociate Professor, Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology Baylor College of MedicineFrancisco J Orejuela, MD

Francisco J Orejuela, MDAssociate Professor Department of Obstetrics and Gynecology Female Pelvic Medicine and Reconstructive Surgery Baylor College of MedicineSection EditorsSusan M Ramin, MD

Susan M Ramin, MDSection Editor Obstetrics Professor of Obstetrics and Gynecology Baylor College of MedicineMartin Weiser, MD

Martin Weiser, MDSection Editor Colorectal Surgery Professor of Surgery Weill Cornell Medical College Member Memorial Sloan Kettering Cancer CenterDeputy EditorVanessa A Barss, MD, FACOG

Vanessa A Barss, MD, FACOGSenior Deputy Editor UpToDate Deputy Editor Obstetrics, Gynecology and Women's Health Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology Harvard Medical School INTRODUCTION

The approach to abdominal pain and the acute abdomen in pregnancy is similar to that in the nonpregnant state, with some additional challenges. For example, the clinician needs to consider physiologic/anatomic alterations related to pregnancy, gestational age and fetal well-being, and causes of acute abdomen that may be more common due to the pregnant state or related to obstetrical complications. Indicated diagnostic imaging and interventions should be performed since delay in diagnosis and treatment can increase maternal and fetal/newborn morbidity and mortality [1,2].

This topic will review issues specific to the diagnostic evaluation and management of abdominal pain and acute abdomen in pregnant and postpartum women. The approach to abdominal pain and acute abdomen in other populations is discussed separately: (See Evaluation of the adult with abdominal pain .) (See Causes of abdominal pain in adults .) (See Evaluation of acute pelvic pain in women .) Subscribers log in here To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you: Mediziner Institutionen Gruppenpraxis Patienten Literature review current through: Oct 2016. | This topic last updated: Jan 6, 2016. The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. 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Topic Outline INTRODUCTIONGENERAL PRINCIPLESDIAGNOSTIC EVALUATIONHistory and physical examinationLaboratoryImaging- Ionizing radiationLaparoscopyDIFFERENTIAL DIAGNOSIS OF ABDOMINAL PAINPregnancy-related causes- First half of pregnancyMiscarriageExtrauterine (ectopic) pregnancy- Second half of pregnancyLaborPlacental abruptionUterine rupturePregnancy-related liver disease- Severe preeclampsia- HELLP syndrome- Acute fatty liverIntraamniotic infectionSpontaneous hemoperitoneumUterine incarcerationArterial dissection and ruptureNonpregnancy-related causes- Pain in the upper abdomenGastroesophageal refluxGallbladder diseaseAcute hepatitisPancreatic diseasesPneumoniaBowel obstructionPerforated ulcerDisorders of the spleenHiatal herniaRectus sheath hematomaAdrenal hemorrhage- Pain in the lower abdomenAcute appendicitisNephrolithiasisInflammatory bowel diseaseDiverticulitis- Diffuse abdominal pain or pain in variable locationsSickle cell crisisTraumaGastroenteritisMesenteric venous thrombosisIliopsoas abscessAbdominal wall painAbdominal wall herniaHereditary angioedemaSpontaneous rupture of the urinary tractGynecologic causes- Ovarian torsion- Fallopian tube torsion- Uterine torsion- Ruptured or hemorrhagic ovarian cyst- Fibroid degeneration or torsion- Pelvic inflammatory diseasePostpartum abdominal pain- Endometritis- Incisional complications- Necrotizing fasciitis- Ovarian vein thrombophlebitis- C. difficile diarrhea with colitis- Urinary retention- Hemorrhage- Adynamic ileus and acute colonic pseudoobstruction (Ogilvie's syndrome)- Hepatic distension and rupture- Abdominal compartment syndrome- Pubic symphysis separation- Foreign body- Unrecognized visceral injury- Intraabdominal or pelvic abscess, surgical soft tissue infection- Myocardial infarctionINFORMATION FOR PATIENTSSUMMARY AND RECOMMENDATIONSREFERENCES GRAPHICS FIGURESLiver disease in pregnancyPatterns of referred abdominal painTABLESNormal reference ranges in pregnant womenCriteria for preeclampsiaPreeclampsia with severe featuresCauses of abdominal pain by locationExtra-abdominal causes abdominal painCauses postpartum pain Smarter Decisions,Better Care

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