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Abdominal Pain in Pregnancy

Abdominal Pain in Pregnancy. Eileen Parrott. Case One. 18 yr old primip at 28/40 Feels generally unwell. Epigastric pain. Reduced fetal movements. What should you do?. Case One. History Uneventful pregnancy so far. Can’t remember any fetal movements today Examination

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Abdominal Pain in Pregnancy

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  1. Abdominal Pain in Pregnancy Eileen Parrott

  2. Case One • 18 yr old primip at 28/40 • Feels generally unwell. • Epigastric pain. • Reduced fetal movements. • What should you do?

  3. Case One • History • Uneventful pregnancy so far. • Can’t remember any fetal movements today • Examination • Temp 36, HR 70, B/P 145/100 • Symphisis fundal height 26cm, FH heard • Investigation • Urine dip, protein ++ • Diagnosis and plan?

  4. Pre-eclampsia • More common in young/old, primip, family history, new partner, multiple pregnancy, medical problems (renal disease, diabetes, antiphospholipid). • Symptoms • Severe headache • Blurred vision • Epigastric pain • Vomiting • Sudden swelling of face and hands

  5. Management • Always remember to check b/p and urine dip in any pregnant woman who is vaguely unwell. • Need same day referral to PDC if:- • Diastolic >90 AND any proteinuria. • Normal b/p with >2+ protein (for 1+ reassess in 1 week) • No protein, but diastolic >100 (if >90, reassess in 24hrs and refer if stays up)

  6. Secondary Care Management • Control blood pressure • Methyldopa or labetalol 1st line. • Atenolol, ACEi, ARBs and diuretics all contraindicated. • Delivery • Solves the problem by removing placenta. • If <34 weeks will try and give steroids 1st

  7. Eclampsia • Any seizure in pregnancy = eclampsia until proven otherwise. • Need ABC and 999. • Remember left lateral/recovery position. • Give 5-10mg PR/IV diazepam. • Secondary care use IV magnesium sulphate infusion.

  8. Case Two • 28 yr old, G2P1 at 29 weeks. • 2 days of central abdominal pain • Several episodes of vomiting. • No diarrhoea. • Fetal movements as normal.

  9. Case Two • Examination • Temp 37.7, B/P 110/60. HR 90. • Uterus measures for dates and FH heard. • Tender and guarding in right flank. • Diagnosis?

  10. Appendicitis • 1/1000 pregnancies. • Due to gravid uterus, appendix is displaced. • Pain may be in flank, subcostal or periumbilical areas. • Fetal mortality 5% and higher risk of perforation (15-20%). • Low index of suspicion and refer.

  11. Case Three • 35 yr old G4P3, 34/40. • Gradual onset of suprapubic, groin and thigh pain. • Getting worse over the last week. • Worse on walking. • Has a waddling gait. • Cause?

  12. Symphisis Pubis Dysfunction • Due to ligament laxity. • More common in multips and increased gestation. • Usually settles within 6 mths of birth. • Treatment • Simple analgesia (paracetamol). • Physio – for brace, crutches and exercises.

  13. Case Four • 29yr old primip at 34 weeks. • Smoker • Sudden onset constant central abdo pain. • No PV bleeding. • Not felt fetal movements

  14. Case Four • Examination • B/P 100/50, HR 100, temp 35.5. • General uterine tenderness. • FH heard, rate 200. • Diagnosis?

  15. Placental Abruption • Detachment of all or part of placenta. • Risk factors – hypertension, smoking, cocaine, trauma. • Presents with abdo pain and fetal distress. • May not be vaginal bleeding in a concealed abruption (blood collects behind placenta). • Need ABC, 999 and urgent delivery.

  16. Case Five • 22 yr old, primip at 32/40. • Abdominal pain, urinary frequency. • No loin pain or temps. • No PV bleeding, baby moving well. • Urine dip leuc ++, nitrites ++ • Diagnose UTI. Which abx?

  17. UTI in Pregnancy • Usually due to E-coli. • Cefalexin 500mg bd or amoxicillin 250mg tds for 7 days. • Avoid trimethoprim (esp 1st trimester) due to teratogenicity. • Avoid nitrofurantoin (esp 3rd trimester) due to neonatal haemolysis.

  18. Any Questions?

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