Can't Miss Diagnoses in the Pregnant Patient With Abdominal

1. Can't Miss Diagnoses in the Pregnant Patient With Abdominal Pain Dr.Tana Kiak Specialist:Obstetrics & Gynecology Contact: tanakiak@yahoo.com

2. Abdominal pain during the first trimester of pregnancy is a common presenting complaint. There are many conditions specific to and related only to pregnancy; however, it is important to remember that any condition causing pain in the non-obstetric patient may also occur in the obstetric patient, although the presenting history and physical examination may be different. Evaluating the pregnant patient with abdominal pain has inherent challenges because nausea, vomiting, and abdominal pain are common in the normal obstetric population. The expanding uterus can displace other intra-abdominal organs and anemia and leukocytosis are common in normal pregnancies and are not as predictive of blood loss or infection. The ultrasound image demonstrates intrauterine fluid and debris without evidence of an intrauterine pregnancy in a patient with an ectopic pregnancy. http://reference.medscape.com/features/slideshow/abdominal-pain?src=mp

3. Normal implantation of the embryo into the uterine lining (illustration shown) can be associated with mild, intermittent cramping that lasts 1 or 2 days and a small amount of vaginal bleeding, called implantation bleeding. The spotting is often minimal and occurs between 6 and 12 days after the date of suspected conception, often on or around the same day as the next expected period. Hence, patients can often mistake it for a mild period. http://reference.medscape.com/features/slideshow/abdominal-pain?src=mp

4. Ectopic pregnancy is the leading cause of first trimester pregnancy-related mortality in the United States, and accounts for 2% of all pregnancies and 9% of all pregnancy-related deaths. An ectopic pregnancy most often occurs due to an abnormality in anatomy or function of the fallopian tube, ovary, or uterus, although approximately 95% of ectopic pregnancies occur in the fallopian tube. Anything that impedes the migration of the embryo to the endometrial cavity could predispose women to an ectopic pregnancy. Risk factors include pelvic inflammatory disease, age, previous ectopic pregnancy, previous tubal ligation, tobacco use, age > 35 years, progesterone-bearing intrauterine devices, and fertility treatment with ovulation induction or ovarian stimulation. http://reference.medscape.com/features/slideshow/abdominal-pain?src=mp

6. By 6 weeks' gestation, all normal pregnancies (defined by a visible yolk sac, a fetal pole, or cardiac motion) should be visible with vaginal ultrasound. The usual finding for an ectopic pregnancy on ultrasound is a mass in the adnexa, fluid in the pelvis, and no visible intrauterine pregnancy. Conclusive diagnosis of ectopic by vaginal probe ultrasound, seen in only about 20% of ectopics, can only be made if fetus or fetal cardiac motion is seen outside the uterus. Heterotopic pregnancies (intrauterine pregnancy + ectopic) are very rare, accounting for 1:5000 pregnancies without fertility agent. The image shown is of an endovaginal sonogram demonstrating an early ectopic pregnancy. An echogenic ring (tubal ring) (arrow) found outside of the uterus can be seen in this view. http://reference.medscape.com/features/slideshow/abdominal-pain?src=mp