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IN PREGNANCY
BY
DR E.O .OBI-THOMAS
INTRODUCTION
reassurance
Other physiological
causes
Heartburn- give anti-acids or H2
antagonist if severe
Excessive vomiting –dietary
adjustment ,infusion and antiemetics
Constipation –dietary adjustment,
avoid iron therapy and give laxatives
Pathological conditions
in pregnancy
Divided into :
-related to uterus
-related to adnexae
RELATED TO UTERUS
-Miscarriage, fibroid, placenta abruption,
chorioamnitis,preterm labour and uterine
rupture
Miscarrage
Common in the first trimester
Vaginal bleeding
Cramp like pain
Could be confirmed using ultrasound
Uterine fibroid
-usually asymptomatic
-occasionally complicate pregnancy
-may interfere with conception and
maintenance of pregnancy
-10% of women with uterine fibroid experience
abdominal pain due to red degeneration or
carneous degeneration
-Pain and tenderness are usually localized
-low grade fever and leucocytosis
During labour degeneration can mimick
placenta abruption
Pain can be from torsion of pedunculated
fibroid
Can lead to obstructed labour, abdominal
lie
Avoid unnecessary operations
Mgt is conservative: analgesia ,bed rest
c/section
Caeserean myomectomy ( controversial)
Placenta abruption
Acute pain in later pregnancy
Associated commonly with HBP,
smoking multiple pregnancy,uterine
myomas
Could be concealed or overt
Mgt is variable based on
presentation,fetal viability maternal
stability, cervical status
Chorioamnnits, preterm labour cause
pain
Uterine rupture
Rupture of unscarred uterus prior to labour is
uncommon
Occurs commonly in malformed uterus,excessive
oxytocin doses, obstructed labour high parity
Rupture of scarred uterus may occur either
before or during labour
Maternal hypovolemia is associated risk
Mgt –careful evaluation, resusciatation,
exploratory laparotomy and sterilization
Related to adnexae
Ectopic pregnancy
Ovarian pathology
Ectopic pregnancy
-must be considered in any woman in the
1st trimester with lower abdominal pain
-Usually associated with some bleeding
per vagina
-Pain is typically unrelenting especially
with ruptured type
-Serial BhcG assays ,transvaginal
sonography and laparoscopy are of value
in early diagnosis
Ovarian pathology
-corpus luteum, ovarian cyst
haemorrhage and ovarian cyst torsion.
Most ovarian cysts in pregnancy are
presumably corpus luteum cysts
Persistence and growth of cl causes
aching pelvic pain particularly in the first
trimester
Torsion of an ovarian cyst
-presents with pain ,vomitting ,nausea
pyrexia tachycardia
Leucocytosis
Mimicks ectopic pregnancy acut appendicitis
Mgt
Laparotomy is essential
-if adnexae appear necrotic or vessels
appear thrombosed avoid untwisting
the pedicle.Risk of embolization
If corpus luteum is removed in the 1st
eight weeks give progesterone up to 10
weeks of amenorrhoea
Pathological conditions
These are treated –GIT, UT, LIVER DX
,OTHERS
GIT
-acute appendicitis ,intestinal
obtruction,acute cholecystitis and
cholelithiasis crohn’s dx peptic ulcer
dx and acute pancreatitis
Acute appendicitis
Complicates 1:1500 pregnancies
Can present with anorexia, nausea vomiting
Anatomical location of appendix in pregnancy
varies along RIF and RLR
Acute appendicitis can be confused with
endometriosis of the appendix
Preterm labour ,abruptio placenta,carneous
fibroids ,ruptured adnexal cyst or torsion
mimics acute appendicitis
Presentation is atypical
Delay can lead to rupture
Mgt- rescusitation,laparotomy with R
paramedian incision at the site of maximal
tenderness
Tocolysis
antibiotics
Urinary tract infection
Acute cystitis acute pyelonephritis and
urolithiasis
Acute cystitis