Abdominal pains during pregnancy
ABDOMINAL pains, more so those occurring in pregnancy, are always a great concern for women and physicians.
Obstetrician-gynaecologist Dr Sean Parkinson said when this happens, a patient’s first question is, “Am I losing the baby?” But while this is a possibility, Dr Parkinson explained that it would depend on what stage of pregnancy the woman is at.
“In early pregnancy you’re wondering if you’re losing the baby, in the latter part of pregnancy you’re wondering if you’re in labour, so that’s the concern,” he said.
Dr Parkinson said with regards to abdominal pains, if you haven’t had an ultrasound to establish that it’s a viable pregnancy and it’s in the right place — meaning inside the uterus which is where a normal pregnancy should take place — then abdominal pain is going to be of some concern.
“You’re now concerned about ectopic pregnancy, meaning it’s not in the uterus. It could be in the tubes or anywhere else. Sometimes it is even floating in the abdomen — what we call an abdominal pregnancy,” Dr Parkinson said. “After establishing where the pregnancy is, if it is ectopic it is going to be treated either by surgery or sometimes medically with an injection.”
Dr Parkinson added that if you have a normal pregnancy in the uterus, abdominal pains could be a result of:
1. A miscarriage
If this is the case, according to the ObGyn, the patient will be asked questions about the pain, such as if it is cramping, how long it’s lasting, and if there’s bleeding or fleshy material in the blood.
2. UTI
Dr Parkinson said pregnancy increases the risk of UTIs, so if there is any burning while passing urine, odour, or cramping in the tummy when you pee, the possibility of a UTI will be examined.
3. Fibroids
“As ObGyns we have to ask the patient about any history of fibroids because fibroids can degenerate in pregnancy and cause pain,” he said.
4. Ovarian cysts
The ObGyn explained that during pregnancy, cysts can tort or twist, as well as burst and leak fluid, causing pain.
Dr Parkinson said you’ll want to check out any pain in early pregnancy, especially if it’s persistent and recurrent.
“When you check the duration, if it is getting more intense, lasting longer, and persistent where it’s coming on, you may want to check it out. Also, it has to be different from having a few cramps, but when it’s coming on very often, persisting, or the intensity is increasing, check it out,” he said.
Dr Parkinson added: “Physicians are very cautious with pregnant women because you don’t want to be told ‘if you had checked it out earlier’, so once they present with early pain we will check it out.”
Outside of obstetric causes for abdominal pains, Dr Parkinson said there are other things a physician will screen for, as the woman is not just a pregnant patient.
These things include:
1. Appendicitis
2. Cholecystitis
3. Peptic ulcer disease
4. Gastritis
5. Pancreatitis
In the middle of pregnancy or in the second trimester, the ObGyn said abdominal pains could be an indication of a ruptured ovarian cyst or even a miscarriage.
In the third trimester, he said once a patient presents with abdominal pains, one of the things that come to mind is placental abruption.
“This is the separation of the afterbirth or placenta from the wall of the womb. If not detected quickly, the baby can die. It presents with abdominal pain and bleeding. There are some cases where the placental abruption is concealed and there is pain but no bleeding. The bleeding is hidden inside the uterus. While that is going on, the baby may suffocate,” he explained.
Dr Parkinson said more benign incidences include:
1. Irregular tightening of the abdomen
2. Ligamentous pain
Dr Parkinson said this is common in the later part of pregnancy where the woman feels pain in her abdomen and groin region. “It feels like ‘stitches’ and is diagnosed based on what the patient tells us. They usually feel pressure and pain in the groin,” he said.
3. Pubic symphysis diastasis
Dr Parkinson said this is when the pubic bone where the baby will be resting on starts to open up causing severe pain, difficulty walking, getting out of bed and standing.
4. Gastroesophageal reflux disease
“Pregnancy increases the occurrence of reflux as stomach emptying is delayed so the acid comes back up,” Dr Parkinson said.
5. Back pains
The ObGyn said any worsening of back pains should be checked out as it can be a sign of labour.
6. Early labour
“Women may feel irregular
pain, and feel the entire abdomen tightening. Initially it may be for a short duration and irregular, and then later on it may become more frequent, lasting longer, and with stronger intensity. Some patients may start dilating and don’t know. So I suggest that once you start having any abdominal pains, see your doctor soon in order to be examined and especially to ensure that you’re not going into early labour,” Dr Parkinson said.
