Here’s Everything You Need to Know About Pregancy & Stomach Pain

Dealing with stomach pain during pregnancy comes with its own set of challenges, including difficulties in physical examination, changes in lab results, and hesitation in using certain diagnostic techniques. The causes of stomach pain during pregnancy can be related to the pregnancy itself or unrelated to it. Some conditions can be triggered by pregnancy, while others may have different origins but appear similar to stomach pain.

Ultrasound is the preferred imaging technique during pregnancy because it is readily available, portable, and does not involve ionizing radiation. Laparoscopy, a surgical procedure, is considered a safe and effective option, and the open-access technique is considered safer than the closed technique.

Causes of Stomach Pain During Pregnancy

Pregnancy-related causes (Obstetric):

• Early pregnancy: Miscarriage, Ectopic pregnancy, Molar pregnancy, Ovarian cyst (Torsion, Hemorrhage, Rupture), Degeneration of uterine fibroids, Round ligament pain
• Late pregnancy: Placental abruption, AFLP (Acute Fatty Liver of Pregnancy), Abdominal pregnancy, HELLP Syndrome, Rupture uterus, Fibroid degeneration, Fallopian tube torsion, Uterine torsion, Rupture rectus muscle, Polyhydramnios, Symphysis diastasis, Intraperitoneal bleed

Non-pregnancy-related causes (Non-Obstetric):

• Exacerbated by pregnancy: Extra abdominal etiology
• Surgical: Appendicitis, Cholecystitis, Biliary colic, Acute pancreatitis, Peptic ulcer, Urolithiasis, Intestinal obstruction, IBD (Inflammatory Bowel Disease), Rupture aneurysm, Trauma
• Medical: Gastroenteritis, Porphyria, Sickle cell crisis, Deep vein thrombosis, GERD (Gastroesophageal Reflux Disease), Gall bladder diseases, Acute cystitis, Acute pyelonephritis, Musculoskeletal pain, Cardiac pain, NSAP (Non-specific abdominal pain), Pleuritic pain, Psychological causes, Drug abuse or withdrawal, Herpes zoster infection

ACUTE ABDOMEN PAIN IN PREGNANCY

KEY POINTS FOR HANDLING STOMACH PAIN DURING PREGNANCY

• Take a comprehensive approach to diagnose and treat stomach pain.
• Classify it into pregnancy-related and non-pregnancy-related causes.
• The growing uterus can affect nearby organs and stretch the abdominal wall, leading to typical clinical signs.
• Pregnancy-related changes in blood and biochemical parameters may affect lab results.
• Acute Appendicitis is the most common non-obstetric cause.
• Life-threatening obstetric causes include ruptured ectopic pregnancy, placental abruption, and uterine rupture.
• Ultrasonography is the first choice for imaging.
• Consider MRI without gadolinium as a secondary imaging option.
• Perform the Kleihauer-Betke test in cases of major trauma.
• Consult a multidisciplinary team involving surgeons, radiologists, and critical care physicians.
• Do not delay surgical intervention when in doubt.
• Laparoscopic surgery is safe and feasible in specific situations

Dr. SHYAMALA MUNDUMULA,  MBBS, DGO, DNB Consultant – Obstetrics and Gynecology, BirthRight by Rainbow Hospitals, L B Nagar, Hyderabad

Dr. Shyamala Mundumula

Consultant at Rainbow Children’s Hospital

L B Nagar