Intro
Abdominal pain is commonly experienced by women during pregnancy. While it mostly occurs due to normal physiological and anatomical changes in the mother to support the growth of the baby, other important pathological causes both related and unrelated to pregnancy could also be present.
Proper attention is needed to assess and address any serious conditions related to abdominal pain before attributing it to normal changes in pregnancy. Some clinical features could hint at a more serious underlying condition such as any changes in severity, pattern, or timing of the pains as well as accompanying symptoms (such as nausea, vomiting, urinary symptoms, and fever). Thus, it is important to seek professional medical care if you are experiencing the symptoms mentioned to prevent any possible harm to yourself or your pregnancy.
In this post, we aim to review some of the common causes of abdominal pain in pregnancy related to different diseases and try to identify differentiating symptoms.
HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets)
HELLP syndrome is one of the most serious complications of pregnancy which could be fatal to both the mother and the baby. As this condition is closely associated with eclampsia (another complication of pregnancy that we discussed in previous posts), it often occurs toward the later stages of pregnancy.
Patients may experience abdominal pain localized at the right upper quadrant of the abdomen, as well as headaches, nausea, vomiting, high blood pressure, vision changes, and altered mental state in advanced stages.
Management includes maintaining blood pressure, prevention of seizures, and correction of any blood clotting abnormalities while preparing to terminate the pregnancy with a cesarean section.
Appendicitis
Appendicitis (inflammation of the appendix due to infectious or non-infectious causes) is one of the common causes of abdominal pain in all populations. It can happen in pregnancy almost at the same rate as it does in other populations. However, due to the changes in the normal anatomy of the internal organs in pregnancy, the clinical presentations might differ from those in non-pregnant individuals.
Some of the classic manifestations include sudden moderate-to-severe abdominal pain which could be accompanied by nausea, vomiting, or fever.
This is a serious condition that, if untreated, may pose the risk of the rupture of the appendix, increasing the risk of fatal damage to the fetus and pregnancy.
Gallbladder Stones
The gallbladder is an internal organ that stores and releases digestive fluids into the small intestine and helps with the digestion of food. This organ is prone to different diseases such as stone formation or inflammation.
Pregnant women are at an increased risk of developing gallbladder stones (Cholelithiasis) due to hormonal changes.
Patients may experience intermittent abdominal pain, especially after having a meal, localized toward the right upper quadrant of the abdomen (known as the biliary colic). This may be accompanied by nausea and vomiting, or fever in case of inflammatory processes. However, not everyone with a gallbladder stone experiences these symptoms.
Depending on the severity of symptoms, watchful waiting may be considered as opposed to endoscopic or surgical intervention for the removal of the stone or the gallbladder.
Gallbladder Inflammation
Inflammation of the gallbladder (Cholecystitis) is most often caused by stones. This may present with severe abdominal pain accompanied by nausea, vomiting, and fever. This condition poses a more serious risk to the patient’s health and the pregnancy, as there is an increased risk of gallbladder rupture.
Patients are often managed surgically as delayed intervention could be fatal to the mother and the pregnancy.
Urinary Tract Infections
Urinary Tract Infections (UTIs) are more common during pregnancy, due to anatomical and hormonal changes that increase the pressure on the bladder. While many do not experience any specific symptoms despite the presence of infection, others may experience abdominal pain (more in the lower segments), a burning sensation with urination, and an increased frequency of bathroom visits with some urgency sensation.
If left untreated, the infection may involve kidneys and lead to systemic involvement, leading to more severe symptoms such as fever and flank pain and posing a serious threat to a healthy pregnancy. Management often includes safe-to-use antibiotics during pregnancy.
Kidney Stones
Kidney stones (Urolithiasis) are another common cause of abdominal pain and hospitalization among pregnant women. Pregnant women face an increased risk due to reduced motility and increased pressure in the urinary system.
Patients may experience intermittent abdominal, flank, or lower back pain associated with nausea and vomiting, fever, and urinary symptoms (including a burning sensation while urination and a sensation of urgency and frequency to visit the restroom). The pain may be one of the most severe pains experienced by the patient. Symptoms may vary depending on the location of the stone in the kidney, urinary tract, or bladder.
Management often includes pain control and attention to the patient’s hydration status while in some cases (such as single kidney, large stones, and worsening of symptoms) surgical intervention may be considered.
Small Bowel Obstruction
Small Bowel Obstruction (SBO) is one of the common causes of abdominal pain in pregnant women. It can be present due to different etiologies, but one of the most common causes is adhesion from previous surgeries, such as cesarean section. As a result, women with a history of CS delivery are at increased risk of developing SBO.
Patients may experience abdominal pain, nausea and vomiting, and fever in more advanced cases. Understanding the underlying cause of SBO is crucial to deciding the management steps, with conservative approaches in milder cases due to adhesions and more aggressive surgical approaches in more serious underlying conditions.
If left untreated, serious outcomes can be expected such as rupture of the small intestine, threatening the life of the mother and pregnancy.
Conclusion
To summarize, while normal physiological and anatomical changes of pregnancy are the cause behind most of the abdominal pain experienced by pregnant women, proper assessment by a healthcare professional is needed to identify and manage some serious conditions, as discussed above, which pose serious risks to the mother’s health and the pregnancy.
In case you are experiencing abdominal pain during pregnancy, it is recommended to contact your healthcare provider promptly to undergo a proper and professional assessment.
