Presentation on theme: "Abdominal Pain in Pregnancy Eileen Parrott. 18 yr old primip at 28/40 Feels generally unwell. Epigastric pain. Reduced fetal movements. What should you."— Presentation transcript:
Abdominal Pain in Pregnancy Eileen Parrott
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 Temp 36, HR 70, B/P 145/100 Symphisis fundal height 26cm, FH heard Investigation Urine dip, protein ++ Diagnosis and plan? Case One
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 Pre-eclampsia
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)
Secondary Care Management Control blood pressure Methyldopa or labetalol 1 st line. Atenolol, ACEi, ARBs and diuretics all contraindicated. Delivery Solves the problem by removing placenta. If <34 weeks will try and give steroids 1st
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. Eclampsia
28 yr old, G2P1 at 29 weeks. 2 days of central abdominal pain Several episodes of vomiting. No diarrhoea. Fetal movements as normal. 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? Case Two
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. Appendicitis
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?
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.
Case Four 29yr old primip at 34 weeks. Smoker Sudden onset constant central abdo pain. No PV bleeding. Not felt fetal movements
Case Four Examination B/P 100/50, HR 100, temp General uterine tenderness. FH heard, rate 200. Diagnosis?
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.
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?
UTI in Pregnancy Usually due to E-coli. Cefalexin 500mg bd or amoxicillin 250mg tds for 7 days. Avoid trimethoprim (esp 1 st trimester) due to teratogenicity. Avoid nitrofurantoin (esp 3 rd trimester) due to neonatal haemolysis.