Chapter 19

Other causes of abdominal pain in early pregnancy

Urinary tract infection

-Lower urinary tract infection is common in pregnancy

- increased risk of ascending infection. - Acute pyelonephritis occurs in 1–2% of

pregnant women. -The clinical features include : -fever,

loin tenderness and urinary frequency. - Treatment :intravenous antibiotics,

fluids and adequate analgesia.

Urolithiasis

-Urinary calculi in pregnancy -sudden onset abdominal pain - associated with urinary tract infection

and haematuria. -Ultrasound :unilateral hydronephrosis or

a calcified area are suggestive of renal calculi.

The management intravenous fluids, antibiotics and effective analgesia.

- If a calculus is large enough to cause obstruction then surgery may be required

Appendicitis

There is no increase in incidence during pregnancy but mortality is higher.

During pregnancy the caecum and appendix are displaced upwards and to the right with advancing gestation.

The pain is less well localized and tenderness, rebound and guarding less obvious.

This leads to delay in diagnosis and treatment and an increased incidence of perforation (15–20% of cases)

peritonitis and sepsis. When perforation occurs, maternal and fetal mortalityincrease

surgical treatment is essential,accomplished by laproscopy

Cholecystitis

-sudden onset of right upper quadrant or epigastric

-colicky pain with associated nausea, vomiting and fever.

-Jaundice is uncommon. - The diagnosis ; -clinical picture -biochemical tests

- the presence of stones in the biliary tree on ultrasound scan.

- The treatment : -antibiotics - adequate analgesia and fluids. -Surgery is indicated during pregnancy where

there is associated pancreatitis or recurrent episodes but otherwise is deferred until after the puerperium

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