Abdominal pain in pregnancy: a rational approach to management

Abdominal pain during pregnancy is a relatively common symptom. It may reflect 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 preterm labour and uterine rupture present with acute abdominal pain. Pregnancy also may predispose to certain clinical conditions like 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 characterized 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 intraperitoneal infection or haemorrhage may result in such an ‘emergency’. It is important to realize 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 impact on diagnosis and management. Timely diagnosis and appropriate treatment of conditions contributing to abdominal pain and acute abdomen during pregnancy, is likely to improve maternal and perinatal outcome.