Abdominal Pain in Pregnancy

This Element discusses the evaluation and management of abdominal pain in pregnancy. It highlights safe imaging approaches, including ultrasound and MRI, and outlines when surgery may be needed, emphasising minimally invasive techniques and coordinated care.

Abdominal pain during pregnancy may be due to the physiological changes or to a pathological condition. A careful history and thorough clinical assessment are required. Pregnancy related disorders, such as ectopic pregnancy and rupture of a corpus luteum are often easy to diagnose; Others, such as ovarian cyst torsion, acute appendicitis and cholecystitis as well as some less common conditions may be more difficult to diagnose. Ultrasound scan is a key investigation, and diagnostic in most cases. Magnetic resonance imaging (MRI) may be required and is safe in pregnancy. Computerised Xray tomography (CT scanning) is not generally recommended as it involves radiation and has no compensating advantages. For surgery the laparoscopic approach is recommended and can be performed at any gestation, although it is particularly suitable in the second trimester. Anesthetic assessment, correct positioning of the patient and particular care during abdominal entry are important safety precautions. Most procedures can be performed by the gynecologist, though involvement of a general surgeon is advisable in cases where organs other than the reproductive tract are likely to be involved.