Pain in the abdomen,also called locally as ‘stomach’ pain, is a common cause for pregnant women to visit the doctor’s office. In most cases the problem is not serious, but all cases need careful assessment as some women might need immediate surgery – while others can wait to see the doctor the next day, and others can wait until their next prenatal doctor’s appointment. The woman’s history and clinical examination are crucial in making the correct diagnosis.
What are some common causes of abdominal pain in the first half of pregnancy?
In this article the first half of pregnancy is considered as twenty weeks of pregnancy or five months of pregnancy. The same pain might also occur in the second part of pregnancy as well, and in some cases the pain might occur in both the first part and continue into the second half of pregnancy.
Pain related to the uterus (womb)
Miscarriage – One of the most common causes of pain in early pregnancy is that of spontaneous miscarriage. The pain usually comes when the miscarriage has passed the threatened stage. The uterus squeezes clot and decidua through the mouth of the womb, thus causing recurrent pains which in some cases can become very severe. Many people are not aware that spontaneous miscarriages are very common, occurring in approximately 25% of all pregnancies.
Fibroids – Fibroids are very common in women of the Caribbean. In pregnancy, fibroids can undergo twisting (torsion). A condition called red degeneration can also occur in the fibroids especially between 12-18 weeks of pregnancy.
Pain related to the Fallopian tubes
Ectopic pregnancy – An ectopic pregnancy is one of the most serious conditions that can occur in early pregnancy. Unruptured ectopic pregnancy causes chronic symptoms and needs to be managed in the hospital, whereas ruptured ectopic pregnancy produces acute (sudden) symptoms and collapse and needs urgent hospital admission and management by an experienced obstetrician/gynaecologist.
Pain from the pelvic ligaments
Round ligament – As the pregnant uterus enlarges it stretch the round ligaments on both sides. Usually the ligaments stretches easily, but if the pull is too rapid small bleeding occurs and a clot might form. This results in pain usually around 16 to 20 weeks gestation.
Pain from the ovaries
Ovarian swellings (tumours) – In early pregnancy an ovarian cyst might rupture and bleeding might occur causing sudden pain.
Torsion of an ovarian mass or tumour might also occur and result in pain.
Extra pelvic causes
Urinary tract infections are common causes of pain in early pregnancy. Pyelonephritis can also cause abdominal pain in pregnancy.
Vomiting – Though many women who vomit in pregnancy have little upset, vomiting may be sufficiently severe to cause muscle ache from the stretch. The pain usually settles down as the vomiting decreases.
Appendicitis – Appendicitis and pregnancy both occur in young women and therefore may occur concurrently by chance. The diagnosis of appendicitis in pregnancy can be challenging for some doctors. For this reason – and the reluctance of general surgeons to operate on pregnant women – it has led to high rates of death and morbidity in pregnancy of patients who had appendicitis. The treatment for appendicitis in pregnancy is to operate. Anyone suspected of having appendicitis in pregnancy should have a laparotomy by an experienced surgeon and obstetrician.
Other causes
There are other causes of abdominal pain in early pregnancy but these are less common, such as gall-bladder disease, large bowel disorders and small bowel colic following gastroenteritis. Kidney stones and stones in the ureter can also cause pain in the first half of pregnancy.
Diagnosis
The clinical history and examination are crucial in the diagnosis. Other tests and investigations might help – such as an ultrasound scan and laparoscopy. The nurse or doctor in accident and emergency unit must carry out a careful assessment of all pregnant women who present with pain as this assessment will determine if hospitalization is required or not, and whether urgent referral to the gynaecologist is needed.
Management
The management will depend on the specific cause of the abdominal pain. In the vast majority of cases the cause of the pain can be identified and treated, and the pregnancy will progress without complications.
Conclusion
Most women who present with abdominal pain in early pregnancy may have nothing serious. Pain can, however, lead the obstetrician/gynaecologist to diagnose a serious condition when action needs to be taken urgently. All pregnant women are encouraged to have their regular prenatal visits, but if they have acute abdominal pain they should seek medical attention at all times.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
