Consultant Corner: Abdominal Pain and the Pregnant Patient

Abstract

Acute care providers should consider a broad differential diagnosis for abdominal pain in pregnancy. Sources for pain include pregnancy-related pain as well as musculoskeletal, gastrointestinal, urologic, gynecologic, and neuropathic etiologies of pain. Abdominal pain in pregnancy is especially challenging because the gravid uterus displaces the viscera and confounds physical exam findings as the pregnancy progresses. Elevations in progesterone cause smooth muscle to relax, which exacerbates painful symptoms of GERD, bloating, and constipation. Progesterone also causes ureteral relaxation, and, when coupled with compression by the gravid uterus, the resulting urinary stasis increases the risk of pyelonephritis. Pregnancy-specific laboratory reference ranges should be used, as maternal physiology changes significantly in pregnancy. The best way to ensure the health of the pregnancy is to ensure the health of the mother.