Case & Commentarypart 1
A 34-year-old woman who was 14 weeks pregnant presented to the emergency department with 5 days of nonspecific abdominal pain, nausea, and vomiting. On examination, she appeared well with normal vital signs and had some mild diffuse abdominal tenderness. Her white blood cell count was 19,000 cells/L, and a urinalysis was positive for nitrates and leukocyte esterase . She was diagnosed with a urinary tract infection and was discharged on antibiotic therapy. No imaging was performed at this initial visit.
The patient returned the following day with unchanged abdominal pain and more nausea and vomiting. A fetal ultrasound was performed and found normal fetal heart activity. No further testing was done, and she was discharged home with instructions to continue the antibiotics.
Abdominal pain remains the most common reason for emergency department visits, comprising more than 11% of all visits in 2008. In 2011, 54% of patients that presented to the ED were female, more than 25% were of childbearing age, and the pregnancy rate in the United States is approximately 10% at any given time. For these reasons, clinicians that evaluate patients with abdominal pain in the ED should be familiar with common causes of abdominal pain in pregnant women and appreciate when nausea and vomiting in pregnancy is abnormal.
Stomach Pain During Pregnancy: Causes And Treatment
Upper stomach pain pain during pregnancy can be a normal part of the process as your body changes to accommodate your growing baby. While there are many harmless causes of this abdominal pain, some may be more serious. As an expectant mother, it is important to educate yourself on all potential causes so you are able to recognize symptoms that may cause concern.
When To Call A Doctor
Abdominal pain during pregnancy warrants a call to the doctor if the following signs appear.
- Any pain or bleeding during the first and third trimester
- Accumulation of water or swelling of hands, face, or feet
- Severe pain with or without vaginal bleeding
- Vision problems sensitivity to light, blurred vision
- Fever, chills, headache, nausea, or vomiting
- Pain while urinating or foul-smelling urine
- Recurring and equally timed contractions that seem progressive.
All pains during pregnancy may not be a cause for concern. However, it is better to know the multiple factors that may affect the safety of you and your baby. If you are concerned about the pain, it does not harm giving a doctor a call. The chances are that these pregnancy cramps are normal, and you will feel better quickly.
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My Child Hates Their Playpen What Do I Do
Am I pregnant?
One of the special things about pregnancy is that no two women experience it in the same way. One woman doesn’t stop vomiting for weeks in the first trimester, and another might never even feel nauseous .
There are several early signs of pregnancy. Some of them are subtle, and you may not notice them right away, or you may mistake them for PMS since they are similar. In fact, in one study, 29% of women reported that missing their period was their first clue that they were pregnant.2
You’ll probably want to know if you’re pregnant sooner rather than later since it’s important to receive appropriate prenatal care and discontinue any unhealthy habits you may have.
If you are experiencing any of the symptoms below, and if you’ve missed a period, you should definitely take a pregnancy test. It’s the only way to know for sure if you’re pregnant or not.
Information About Placental Abruption
The placenta processes your babys nutrients, waste and oxygen by bridging your babys blood circulation with that of your own. It sits inside the womb alongside your baby, and is attached to the wall of the womb. It is linked to the baby by umbilical cord, which is attached to the babys abdomen.
Placental abruption and low-lying placenta are conditions linked to the placenta that can cause premature birth.
Placental abruption is a serious condition in which the placenta starts to come away from the inside of the womb wall before the baby has delivered. This is an emergency because it means that the support system for the baby is failing.
Studies show that placental abruption affects up to 1% of pregnancies . In this condition some or all of the placenta separates from the wall of the womb before the baby is delivered. This can be caused by an impact such as a car crash, or may be related to a condition such as pre-eclampsia or fetal growth restriction, also know n as Intrauterine growth restriction or IUGR.
When placenta abruption happens the placenta is damaged and the baby may not be supported to develop properly.
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Can It Be Ectopic Pregnancy
An ectopic pregnancy occurs when your fertilized egg cell is implanted not inside your womb, but rather, outside your uterus. This condition will manifest itself early on in your pregnancy, and may cause you to suffer from spotting and tenderness in your abdomen. If left untreated, this condition may cause your fallopian tube to rupture, risking both your health and your babys life.
Skin Stretching And/or Muscle Pain
As your pregnancy continues into the second and third trimesters, your growing bump may stretch your skin tight. The added weight can also put extra pressure on your muscles.
In addition to remembering to moisturize to keep your skin hydrated and stretch marks to a minimum, you may find maternity belts/belly bands helpful when the weight of your growing belly is bothering you.
Pregnancy pillows can help you find a supported position for your body to rest while lounging, watching tv, or sleeping.
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Serious Causes Of Abdominal Pain In Pregnancy
Most causes of abdominal pain during pregnancy are nothing to worry about, but some causes of abdominal pain need medical care right away. If you suspect you may be facing one of the following problems, get medical assistance immediately.
Appendicitis. Appendicitis is an infection of your appendix, which can happen even during pregnancy and needs immediate treatment. Appendicitis causes:
- Pain on your right side
- Stomach pain near your belly button
Constipation And Trapped Wind
You probably know what constipation and trapped wind feels like. Unfortunately, it can get worse during pregnancy – the culprit is usually hormonal changes that slow down the whole digestive process. To combat wind and constipation, try drinking lots of water, eating fibre-rich foods, or talking to your doctor or midwife about taking something to get things moving again.
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How Is Ectopic Pregnancy Treated
Unfortunately, the only way to treat an ectopic pregnancy is to end the pregnancy. This can be very distressing, and you may need support afterwards to come to terms with what has happened.
Your healthcare team will talk to you about your options and what this means for you. Not all these options will be suitable and will depend on:
- how many weeks pregnant you are
- your symptoms
- if there is a lot of bleeding in your stomach
- your hCG levels
- what is available at your local hospital.
Its important that you understand all your options and what this may mean for you and your ability to get pregnant again . Dont be afraid to ask as many questions as you need to and raise any concerns you have about what is happening.
There are 3 treatment options for an ectopic pregnancy.
What Causes Mild Belly Pain In Pregnancy
There are different causes for mild achiness or pain in the abdomen during the different stages of pregnancy.
- Some women have low, period-like pain or cramps early in pregnancy. But if pain is severe or felt on one side, call your health care provider right away.
Later in pregnancy
- As your belly grows, the muscles and ligaments that support your uterus stretch. This can cause a dull ache across the belly or a sharp pain on one side. Many women feel this pain most severely when getting up from a bed, chair or bathtub or when coughing.
- Gas pains and bloating may be caused by hormones that slow your digestion, the pressure of your growing uterus, constipation and heartburn.
- You may feel irregular contractions or tightening of your uterus muscles, often called Braxton-Hicks or false labor. False labor is usually painless, but some women feel pain. False labor tends to increase in the weeks right before your due date and can be confused with true labor.
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When To Call The Doctor
Don’t hesitate to call your doctor if you feel like something’s not quite right. “If you have anything that you’re concerned about, you should contact your OB-GYN or be seen,” says Rebecca Shiffman, M.D., director of Maternal Fetal Medicine at Lincoln Hospital in Bronx, New York. “That’s what we’re here forto provide answers to pregnant women and to provide whatever care they need.” Always call your doctor right away if you have any of these symptoms:
- Abdominal pain with or without bleeding before 12 weeks
- Bleeding or strong cramping
- More than four contractions in an hour for two hours
- Severe abdominal pain
How Soon Can You Get Symptoms And Signs Of Pregnancy
Most pregnancy symptoms will start to appear around five or six weeks after your last menstrual period. Usually symptoms wont appear immediately, as it takes a few weeks to develop them. Having symptoms a few days after sex isnt usually a sign of pregnancy, and can actually be due to something else such as PMS.
However, a missed period, fatigue or morning sickness before this five-week mark could indicate pregnancy, Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife, says. The most common early signs are missing a period and feeling out of sorts and not yourself- often feeling overwhelmingly tired and needing to sleep a lot.
Morning sickness is also common and can take on several forms for different people, such as feeling nauseous at certain times of the day or all day, vomiting, dizziness or a combination of all these. The need to wee a lot can also be common and is caused by changing hormones in the early days, as are tender, swollen breasts which are sensitive when touched.
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Are Abdominal Pains During Pregnancy Normal
As your baby develops and your bump gets bigger by the day, your body will begin to adapt to the little one growing inside you. This extra strain can often lead to mild pregnancy pains such as backache and mild abdominal discomfort such as stretching.
If you are concerned, give your midwife or triage a ring to put your mind at rest. And of course, if theres anything on your mind about your pregnancy, dont forget our expert team is on hand 24/7.
Swelling In The Feet And Legs During Pregnancy
Pressure from your growing uterus on the blood vessels carrying blood from the lower body causes fluid buildup. The result is swelling in the legs and feet.
Additional weight during pregnancy can also make your feet bigger. Plus, pregnancy hormones loosen your ligaments and muscles so your pelvic joints open up to get ready for childbirth. This affects your whole body, even your feet. Call your doctor if any swelling is more than mild or if it suddenly gets worse.
- Try not to stay on your feet for long periods of time. Avoid standing in one place.
- Drink plenty of fluids .
- Avoid foods high in salt .
- Elevate your legs and feet while sitting. Avoid crossing your legs.
- Wear loose, comfortable clothing tight clothing can slow circulation and increase fluid retention.
- Soak your feet in cool water.
- Keep moving. Exercise your legs to keep fluid from building up.
- Don’t wear tight shoes choose supportive shoes with low, wide heels.
- Keep your diet rich in protein too little protein can cause fluid retention.
- Notify your health care provider if your hands or face swell. This may be a warning sign of preeclampsia.
- Rest on your side during the day to help increase blood flow to your kidneys.
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My Stomach Feels Weirddoes Your Stomach Hurt In Early Pregnancy
It depends on what you mean by hurt.
In general, the kinds of pain youll experience in your belly or lower abdomen in early pregnancy are related to:
- Nausea usually happens between two and eight weeks after conception2
- Cramping these can feel similar to pre-menstrual cramps and can be a sign of implantation2
- Bloating and abdominal discomfort similar to PMS symptoms
Below I talk a little more about nausea, which is common in early pregnancy .
So in the sense of feeling nauseous, yes, your stomach can hurt. Some women also feel some light cramping at the very beginning of their pregnancy, which may or may not be accompanied by spotting . This usually occurs around the predicted time of the period or a couple of days before.
Will I Still Be Able To Have A Baby In The Future
For most women, an ectopic pregnancy is a one off event and does not happen again. Even if you have only one fallopian tube, your chance of getting pregnant again is only slightly reduced.
If you do get pregnant again, you may be offered an ultrasound scan at 6 to 8 weeks to confirm that the pregnancy is developing in the womb.
Talk to your GP if you do not want to become pregnant again. Some forms of contraception may be more suitable after an ectopic pregnancy.
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What Causes Upper Stomach Pain During Pregnancy
Nausea, cramping, and muscle pain. Aches and pains are a part of the pregnancy journey. When its your body, though, you may be wondering whether these discomforts are normal or concerning.
How can you tell if that pain youre feeling in your upper stomach is a sign that your baby is growing or that your body needs help?
While we cant promise to know exactly what is going on with your body, the following information explains some of the common causes of upper stomach pain during pregnancy and some general guidelines for when its a good idea to reach out to your doctor. Interested? Here we go
Wondering why youre experiencing that upper stomach pain? Some possible causes, from the more common issues to the rare, include:
Obstetric Causes Of Aap
Pregnancy-related causes for abdominal pain could be physiological or pathological. The physiological causes for abdominal pain in pregnancy may be round ligament pain caused by stretching of the round ligament, pain perceived during fetal movement, and painful Braxton Hick contractions. Round ligament pain can complicate 10%30% of pregnancies and usually occurs during the end of the first trimester and in the second trimester. It is localized to the lower abdominal quadrants radiating to the groin it is a cramp-like pain which is worse on movement and is more common in multiparous women. The concern with round ligament pain is that there is a trend to overdiagnose this benign condition, hence leading to failure or delay in diagnosis of significant pathology. Pathological causes which are life-threatening include ruptured ectopic pregnancy, abruption, HELLP syndrome, acute fatty liver of pregnancy, and uterine rupture.
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Stomach Pains After Eating During Pregnancy
Pregnancy comes with a host of discomforts–women often have morning sickness starting a few weeks after conception, and continue with back pain, heartburn, uterine pain, and a variety of other symptoms 3.** Stomach discomfort is quite common, particularly during the later trimesters of pregnancy, and is due to the size of the baby.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Common Causes Of Abdominal Pain In Pregnancy
Ligament pain, marked by sharp pain in your stomach, hips or groin, occurs as the ligaments that support your uterus stretch and thicken, usually during the second trimester. Its one of the most common causes of abdominal pain in pregnancy and it can be absolutely excruciating, sometimes made worse with prolonged sitting or standing. Your uterus goes from being the size of a lemon to the size of a watermelonthat hurts, says Meredith Alston, MD, an associate professor at the University of Colorado School of Medicine and ob-gyn at Denver Health Medical Center.
Other common causes of stomach pain in pregnancy include:
Constipation. Due to the way that progesterone slows down your GI tract, constipation can be made worse by pregnancy, says Alston. Youll probably know what it feels like: persistent stomach cramps and having fewer than three bowel movements a week.
Heartburn. GERD, or gastroesophageal reflux disease, is also caused by your system slowing down and your growing uterus pushing on the stomach, especially in the third trimester. Your stomach might feel sour and youll have the telltale burn in your chest as acid is pushed up into your esophagus.
Gastroenteritis. Pregnancy doesnt make you immune to stomach bugs. If nausea, vomiting and/or diarrhea accompanies your stomach pain, call your provider. Untreated symptoms could lead to dehydration or preterm labor.
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Tummy Twinges Pinching And Pulling
Some women experience feelings inside their stomachs in the early stages of pregnancy that replicate the sensation of their muscles being pulled and stretched. Sometimes referred to as abdominal twinges, these tingles are nothing to worry about.
Layla Rumble, midwife at The Portland Hospital, which is part of HCA Healthcare UK, said, Abdominal twinges and mild pains are very common during pregnancy and usually nothing to worry about. Twinges and abdominal pain is usually caused by constipation, ligament pain, or trapped wind all of which are a normal part of pregnancy.
Twinges, and pains can be alleviated by regular light exercise, eating smaller, frequent meals, having plenty of fibre-rich foods such as fruit and vegetables, and drinking plenty of water to help empty your bladder regularly.
If you find that you experience intense and ongoing pains, or pain accompanied by bleeding, it is important to seek medical advice from your midwife or GP to rule out anything serious.
What else could it be?If youve been heavily exercising or straining your muscles, you could be experiencing some tension from that, especially if youve focused on ab workouts. A tight stomach can also be due to other factors such as digestive issues, stress or hormonal changes, and doesnt necessarily mean youre pregnant.