Abdominal pain in pregnancy: a rational approach to management

Abdominal pain is a relatively common symptom during pregnancy and may be due to anatomical and physiological changes of the pregnant state, such as the ‘round ligament strain’ or may be due to an underlying pathological process. Various obstetric conditions such as placental abruption, clinical chorioamnionitis, threatened pre-term labour and uterine rupture may present with acute abdominal pain. Pregnancy also may predispose to certain clinical conditions such as urinary tract infection that may present with abdominal pain. Conversely, inflammatory or neoplastic processes that are totally unrelated to the pregnant state may first make their presentation during pregnancy, with acute or chronic abdominal pain. Acute abdomen refers to an intra-abdominal process that is characterised by abdominal pain, tenderness and muscular rigidity, for which an emergency surgery must be considered. Life-threatening conditions such as acute appendicitis, acute pancreatitis and intra-peritoneal infection or haemorrhage may result in such an ‘emergency’. It is important to appreciate that pregnancy may alter the clinical presentation of these life-threatening conditions and hence, may ‘mask’ their classical symptoms and signs, delaying the definitive diagnosis. In addition, the presence of a fetus may affect diagnosis and management. Timely diagnosis and appropriate treatment of conditions contributing to abdominal pain and acute abdomen during pregnancy, is essential to improve maternal and perinatal outcome.