UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Approach to abdominal pain and the acute abdomen in pregnant and postpartum women

Authors
Charlie C Kilpatrick, MD
Francisco J Orejuela, MD
Section Editors
Susan M Ramin, MD
Martin Weiser, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

The approach to abdominal pain and the acute abdomen in pregnancy is similar to that in the nonpregnant state, with some additional challenges. For example, the clinician needs to consider physiologic/anatomic alterations related to pregnancy, gestational age and fetal well-being, and causes of acute abdomen that may be more common due to the pregnant state or related to obstetrical complications. Indicated diagnostic imaging and interventions should be performed since delay in diagnosis and treatment can increase maternal and fetal/newborn morbidity and mortality [1,2].

This topic will review issues specific to the diagnostic evaluation and management of abdominal pain and acute abdomen in pregnant and postpartum women. The approach to abdominal pain and acute abdomen in other populations is discussed separately:

(See "Evaluation of the adult with abdominal pain".)

(See "Causes of abdominal pain in adults".)

(See "Evaluation of acute pelvic pain in women".)

                                                                             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Jan 06 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Kilpatrick CC, Monga M. Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 2007; 34:389.
  2. Kilpatrick CC, Orejuela FJ. Management of the acute abdomen in pregnancy: a review. Curr Opin Obstet Gynecol 2008; 20:534.
  3. Parangi S, Levine D, Henry A, et al. Surgical gastrointestinal disorders during pregnancy. Am J Surg 2007; 193:223.
  4. Cormier CM, Canzoneri BJ, Lewis DF, et al. Urolithiasis in pregnancy: Current diagnosis, treatment, and pregnancy complications. Obstet Gynecol Surv 2006; 61:733.
  5. Stone K. Acute abdominal emergencies associated with pregnancy. Clin Obstet Gynecol 2002; 45:553.
  6. Ryan JP, Pellecchia D. Effect of ovarian hormone pretreatment on gallbladder motility in vitro. Life Sci 1982; 31:1445.
  7. Lurie S, Rahamim E, Piper I, et al. Total and differential leukocyte counts percentiles in normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 136:16.
  8. Acker DB, Johnson MP, Sachs BP, Friedman EA. The leukocyte count in labor. Am J Obstet Gynecol 1985; 153:737.
  9. Baron KT, Arleo EK, Robinson C, Sanelli PC. Comparing the diagnostic performance of MRI versus CT in the evaluation of acute nontraumatic abdominal pain during pregnancy. Emerg Radiol 2012; 19:519.
  10. Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E. MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics 2012; 32:317.
  11. Beddy P, Keogan MT, Sala E, Griffin N. Magnetic resonance imaging for the evaluation of acute abdominal pain in pregnancy. Semin Ultrasound CT MR 2010; 31:433.
  12. Groen RS, Bae JY, Lim KJ. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol 2012; 206:456.
  13. Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril 2009; 92:1243.
  14. Bloom SL, Uppot R, Roberts DJ. Case records of the Massachusetts General Hospital. Case 32-2010. A pregnant woman with abdominal pain and fluid in the peritoneal cavity. N Engl J Med 2010; 363:1657.
  15. Fiori O, Prugnolles H, Darai E, et al. Spontaneous uterine artery rupture during pregnancy in a woman with sickle cell disease: a case report. J Reprod Med 2007; 52:657.
  16. Swaegers MC, Hauspy JJ, Buytaert PM, De Maeseneer MG. Spontaneous rupture of the uterine artery in pregnancy. Eur J Obstet Gynecol Reprod Biol 1997; 75:145.
  17. Practice Committee of American Society For Reproductive Medicine. Increased maternal cardiovascular mortality associated with pregnancy in women with Turner syndrome. Fertil Steril 2012; 97:282.
  18. la Chapelle CF, Schutte JM, Schuitemaker NW, et al. Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry. BJOG 2012; 119:86.
  19. Chao LW, Chen CH. Spontaneous rupture of an ovarian artery aneurysm: case report and review of the literature. Gynecol Obstet Invest 2009; 68:104.
  20. Sakaguchi I, Ohba T, Ikeda O, et al. Embolization for post-partum rupture of ovarian artery aneurysm: case report and review. J Obstet Gynaecol Res 2015; 41:623.
  21. Ramin KD, Ramin SM, Richey SD, Cunningham FG. Acute pancreatitis in pregnancy. Am J Obstet Gynecol 1995; 173:187.
  22. Papadakis EP, Sarigianni M, Mikhailidis DP, et al. Acute pancreatitis in pregnancy: an overview. Eur J Obstet Gynecol Reprod Biol 2011; 159:261.
  23. Karsenti D, Bacq Y, Bréchot JF, et al. Serum amylase and lipase activities in normal pregnancy: a prospective case-control study. Am J Gastroenterol 2001; 96:697.
  24. Ordorica SA, Frieden FJ, Marks F, et al. Pancreatic enzyme activity in pregnancy. J Reprod Med 1991; 36:359.
  25. Kaiser R, Berk JE, Fridhandler L. Serum amylase changes during pregnancy. Am J Obstet Gynecol 1975; 122:283.
  26. Xydas NP, May JH, Henson MC. Maternal serum amylase and lipase profiles in pregnancy: determinations in both once-sampled and multisampled patient cohorts. South Med J 1996; 89:199.
  27. Huang SC, Wu TH, Chen CC, Chen TC. Spontaneous rupture of solid pseudopapillary neoplasm of the pancreas during pregnancy. Obstet Gynecol 2013; 121:486.
  28. Kakarla N, Dailey C, Marino T, et al. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol 2005; 105:1195.
  29. Chase DM, Sparks DA, Dawood MY, Perry E. Cecal volvulus in a multiple-gestation pregnancy. Obstet Gynecol 2009; 114:475.
  30. Essilfie P, Hussain M, Bolaji I. Perforated duodenal ulcer in pregnancy-a rare cause of acute abdominal pain in pregnancy: a case report and literature review. Case Rep Obstet Gynecol 2011; 2011:263016.
  31. Sadat U, Dar O, Walsh S, Varty K. Splenic artery aneurysms in pregnancy--a systematic review. Int J Surg 2008; 6:261.
  32. Selo-Ojeme DO, Welch CC. Review: spontaneous rupture of splenic artery aneurysm in pregnancy. Eur J Obstet Gynecol Reprod Biol 2003; 109:124.
  33. Karmazyn B, Steinberg R, Gayer G, et al. Wandering spleen--the challenge of ultrasound diagnosis: report of 7 cases. J Clin Ultrasound 2005; 33:433.
  34. Tolcher MC, Nitsche JF, Arendt KW, Rose CH. Spontaneous rectus sheath hematoma pregnancy: case report and review of the literature. Obstet Gynecol Surv 2010; 65:517.
  35. Bockorny B, Posteraro A, Bilgrami S. Bilateral spontaneous adrenal hemorrhage during pregnancy. Obstet Gynecol 2012; 120:377.
  36. Tamir IL, Bongard FS, Klein SR. Acute appendicitis in the pregnant patient. Am J Surg 1990; 160:571.
  37. Huerta S, Barleben A, Peck MA, Gordon IL. Meckel's diverticulitis: a rare etiology of an acute abdomen during pregnancy. Curr Surg 2006; 63:290.
  38. Ragu N, Tichoux C, Bouyabrine H, et al. [Complicated diverticulitis during pregnancy]. J Radiol 2004; 85:1950.
  39. Bodner J, Windisch J, Bale R, et al. Perforated right colonic diverticulitis complicating pregnancy at 37 weeks' gestation. Int J Colorectal Dis 2005; 20:381.
  40. Chanrachakul B, Tangtrakul S, Herabutya Y, et al. Meckel's diverticulitis: an uncommon complication during pregnancy. BJOG 2001; 108:1199.
  41. Sherer DM, Frager D, Eliakim R. An unusual case of diverticulitis complicating pregnancy at 33 weeks' gestation. Am J Perinatol 2001; 18:107.
  42. Pelosi MA 3rd, Pelosi MA, Villalona E. Right-sided colonic diverticulitis mimicking acute cholecystitis in pregnancy: case report and laparoscopic treatment. Surg Laparosc Endosc 1999; 9:63.
  43. Wong YS, Liu SY, Ng SS, et al. Giant Meckel's diverticulitis: a rare condition complicating pregnancy. Am J Surg 2010; 200:184.
  44. Longo SA, Moore RC, Canzoneri BJ, Robichaux A. Gastrointestinal Conditions during Pregnancy. Clin Colon Rectal Surg 2010; 23:80.
  45. Johansson ME, Holmström S, Abebe A, et al. Intrauterine fetal death due to echovirus 11. Scand J Infect Dis 1992; 24:381.
  46. Modlin JF. Fatal echovirus 11 disease in premature neonates. Pediatrics 1980; 66:775.
  47. Woodfield CA, Lazarus E, Chen KC, Mayo-Smith WW. Abdominal pain in pregnancy: diagnoses and imaging unique to pregnancy--review. AJR Am J Roentgenol 2010; 194:WS14.
  48. Atakan Al R, Borekci B, Ozturk G, et al. Acute mesenteric venous thrombosis due to protein S deficiency in a pregnant woman. J Obstet Gynaecol Res 2009; 35:804.
  49. Engelhardt TC, Kerstein MD. Pregnancy and mesenteric venous thrombosis. South Med J 1989; 82:1441.
  50. Nelson DB, Manders DB, Shivvers SA. Primary iliopsoas abscess and pregnancy. Obstet Gynecol 2010; 116 Suppl 2:479.
  51. Young OM, Werner E, Sfakianaki AK. Primary psoas muscle abscess after an uncomplicated spontaneous vaginal delivery. Obstet Gynecol 2010; 116 Suppl 2:477.
  52. Delke I. Psoas abscess in obstetrics: uncommon condition with common presentations. Obstet Gynecol 2010; 116 Suppl 2:473.
  53. Satoh S, Okuma A, Fujita Y, et al. Spontaneous rupture of the renal pelvis during pregnancy: a case report and review of the literature. Am J Perinatol 2002; 19:189.
  54. Narasimhulu DM, Egbert NM, Matthew S. Intrapartum Spontaneous Ureteral Rupture. Obstet Gynecol 2015; 126:610.
  55. Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 2010; 202:536.e1.
  56. Smorgick N, Pansky M, Feingold M, et al. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Fertil Steril 2009; 92:1983.
  57. Chohan L, Ramirez MM, Wray CJ, Kilpatrick CC. Laparoscopic management of fallopian tube torsion at 35 weeks of gestation: case report. J Minim Invasive Gynecol 2011; 18:390.
  58. De Ioris A, Pezzuto C, Nardelli GB, Modena AB. Caesarean delivery through deliberate posterior hysterotomy in irreducible uterine torsion: case report. Acta Biomed 2010; 81:141.
  59. Cook KE, Jenkins SM. Pathologic uterine torsion associated with placental abruption, maternal shock, and intrauterine fetal demise. Am J Obstet Gynecol 2005; 192:2082.
  60. Guié P, Adjobi R, N'guessan E, et al. Uterine torsion with maternal death: our experience and literature review. Clin Exp Obstet Gynecol 2005; 32:245.
  61. Fatih FF, Gowri V, Rao K. Uterine torsion in second trimester of pregnancy followed by a successful-term pregnancy. BMJ Case Rep 2012; 2012.
  62. Salani R, Theiler RN, Lindsay M. Uterine torsion and fetal bradycardia associated with external cephalic version. Obstet Gynecol 2006; 108:820.
  63. Albayrak M, Benian A, Ozdemir I, et al. Deliberate posterior low transverse incision at cesarean section of a gravid uterus in 180 degrees of torsion: a case report. J Reprod Med 2011; 56:181.
  64. Strobelt N, Ghidini A, Cavallone M, et al. Natural history of uterine leiomyomas in pregnancy. J Ultrasound Med 1994; 13:399.
  65. Aharoni A, Reiter A, Golan D, et al. Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study. Br J Obstet Gynaecol 1988; 95:510.
  66. Neiger R, Sonek JD, Croom CS, Ventolini G. Pregnancy-related changes in the size of uterine leiomyomas. J Reprod Med 2006; 51:671.
  67. Murray A, Holdcroft A. Incidence and intensity of postpartum lower abdominal pain. BMJ 1989; 298:1619.
  68. Holdcroft A, Snidvongs S, Cason A, et al. Pain and uterine contractions during breast feeding in the immediate post-partum period increase with parity. Pain 2003; 104:589.
  69. Ducarme G, Lidove O, Leduey A, et al. Postpartum thrombosis of the superior mesenteric artery after vaginal delivery. Obstet Gynecol 2008; 111:535.
  70. Garey KW, Jiang ZD, Yadav Y, et al. Peripartum Clostridium difficile infection: case series and review of the literature. Am J Obstet Gynecol 2008; 199:332.
  71. Rouphael NG, O'Donnell JA, Bhatnagar J, et al. Clostridium difficile-associated diarrhea: an emerging threat to pregnant women. Am J Obstet Gynecol 2008; 198:635.e1.
  72. Patel A, Lall CG, Jennings SG, Sandrasegaran K. Abdominal compartment syndrome. AJR Am J Roentgenol 2007; 189:1037.
  73. Anteby EY, Yagel S, Hanoch J, et al. Puerperal and intrapartum group A streptococcal infection. Infect Dis Obstet Gynecol 1999; 7:276.
  74. de Moya MA, del Carmen MG, Allain RM, et al. Case records of the Massachusetts General Hospital. Case 33-2009. A 35-year-old woman with fever, abdominal pain, and hypotension after cesarean section. N Engl J Med 2009; 361:1689.
  75. Hamilton SM, Stevens DL, Bryant AE. Pregnancy-related group a streptococcal infections: temporal relationships between bacterial acquisition, infection onset, clinical findings, and outcome. Clin Infect Dis 2013; 57:870.
  76. Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol 2008; 52:171.
  77. Koul AK, Hollander G, Moskovits N, et al. Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of literature. Catheter Cardiovasc Interv 2001; 52:88.
  78. Petitti DB, Sidney S, Quesenberry CP Jr, Bernstein A. Incidence of stroke and myocardial infarction in women of reproductive age. Stroke 1997; 28:280.
  79. Mather PJ, Hansen CL, Goldman B, et al. Postpartum multivessel coronary dissection. J Heart Lung Transplant 1994; 13:533.
  80. Pabla JS, John L, McCrea WA. Spontaneous coronary artery dissection as a cause of sudden cardiac death in the peripartum period. BMJ Case Rep 2010; 2010.
Topic Outline

GRAPHICS