Abdominal Pain in Pregnancy

Aka: Abdominal Pain in Pregnancy

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II. Causes: Non-Pregnancy Related

  1. Gastroesophageal Reflux disease
  2. Peptic Ulcer Disease or Gastritis
  3. Cholecystitis
  4. Ureterolithiasis
  5. Urinary Tract Infection (cystitis, Pyelonephritis)
  6. Appendicitis
  7. Constipation

III. Causes: Pregnancy Related

  1. Preeclampsia or HELLP Syndrome (>20 weeks gestation)
  2. Acute Fatty Liver of Pregnancy
  3. Ectopic Pregnancy
  4. Placental Abruption
  5. Spontaneous Abortion
  6. Intrauterine Fetal Demise
  7. Round Ligament Pain
  8. Preterm Labor
  9. Blunt Trauma in Pregnancy

IV. Imaging: RLQ Abdominal Pain in Pregnancy (Appendicitis Evaluation)

  1. Abdomen MRI without contrast
    1. Non-contrast MRI is as accurate as with gadolinium contrast
    2. Test Sensitivity: 94% (range 87 to 98%, best efficacy with MR-expert radiologists)
    3. Test Specificity: 97% (range 96 to 98%)
    4. Duke (2016) AJR Am J Roentgenol 206(3): 508-17 [PubMed]
  2. Ultrasound RLQ
    1. Test Sensitivity may be as low as 18%
    2. Test Specificity 99%
  3. Abdomen and Pelvis CT
    1. MRI and Ultrasound are preferred instead due to lack of ionizing radiation
    2. ACR rates CT in pregnancy as "may be appropriate"
    3. Low osmolality iodinated contrast is not associated with known mutagenesis or Teratogenesis
    4. Single Abdomen and Pelvis CT ionizing radiation dose is below exposure known to cause Teratogenesis
  4. References
    1. Broder (2022) Crit Dec Emerg Med 36(7): 20-1

V. References

  1. Gregory (2018) Am Fam Physician 98(9): 595-602 [PubMed]

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