Nonobstetric Abdominal Pain and Surgical Emergencies in Pregnancy

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Key Points

  • Pregnant patients present a diagnostic challenge to emergency physicians.

  • Physiologic changes during pregnancy can alter presentations of common pathology.

  • Imaging should not be delayed when a surgical cause of abdominal pain is suspected.

  • If possible, start with imaging that poses the least risk to the mother and fetus—MRI and ultrasound.

Anatomic and physiologic changes in pregnancy

Pregnancy causes many changes that affect the presentation of acute abdominal pain. Heartburn and constipation are frequent complaints during pregnancy, because of decreased gastric motility. The gravid uterus, considered an abdominal organ at approximately 12 weeks' gestational age, compresses and displaces the underlying and surrounding viscera.4 The expanding uterus makes it difficult to localize pain and can mask or delay the emergence of peritoneal signs.2 Increased laxity of the anterior

Pyelonephritis

A urinary tract infection (UTI) is an infection anywhere along the urinary tract, affecting the bladder, ureter, or kidneys. A UTI is most often caused by a bacterial pathogen and presents as a combination of symptoms: urinary frequency, urgency, or burning. Asymptomatic bacteriuria, that is, the presence of bacteria in a clean-catch urine sample without the typical symptoms or signs of a UTI, is the most common UTI in pregnant women.5 The Infectious Diseases Society of America established 2

Imaging

Pregnant patients presenting to an ED create some tension, particularly in regard to imaging. The use of imaging to aid in the diagnosis of pregnant patients with acute abdominal pain has risen in recent years and is a popular topic of debate in the radiology literature.40 When an emergency physician decides that additional imaging is needed to aid in the diagnosis, then the first choice must be one that exposes the fetus to the least ionizing radiation. Ultrasonography and MRI are thus the

Summary

Abdominal pain is common during pregnancy. When a pregnant patient presents to an ED with an abdominal complaint, several dilemmas emerge in association with the evaluation and work-up. Subtle differences in laboratory values need to be acknowledged when assessing patients. Atypical presentations of common diseases can be seen during pregnancy. The prevalence of abdominal disorders varies based on gestational age; for example, bowel obstruction is more common in the third trimester and

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  • Cited by (20)

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    • Advanced colorectal cancer resulting in acute bowel obstruction during pregnancy; a case report

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      Citation Excerpt :

      Unfortunately, symptoms of abdominal pathology can be either absent or altered during pregnancy, impeding proper diagnosis. Approximately 1 in 500 pregnancies develop an acute abdomen and up to 1% of women require surgery for a non-obstetric problem [6]. Whereas appendicitis, cholecystitis, urinary tract infection, urolithiasis and gastroenteritis are not uncommon; vascular causes, acute pancreatitis and bowel obstruction are infrequently seen in pregnant women [7].

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    The author has no financial relationships that constitute or suggest a conflict of interest.

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