From the Guidelines
The workup for a 21-year-old female who is 7 days postpartum presenting with left lower quadrant (LLQ) abdominal pain should prioritize a thorough history and physical examination, followed by laboratory tests and imaging studies, with a focus on ruling out serious postpartum complications such as endometritis, ovarian vein thrombosis, and abscess formation. The initial evaluation should include a thorough history and physical examination, with particular attention to vital signs, abdominal examination, and pelvic examination. Laboratory tests should include complete blood count to assess for infection or hemorrhage, comprehensive metabolic panel, urinalysis, and urine culture to rule out urinary tract infection. C-reactive protein and/or erythrocyte sedimentation rate can help evaluate for inflammation. Blood cultures should be obtained if fever is present.
Imaging Studies
Imaging studies should include a pelvic ultrasound to evaluate for retained products of conception, ovarian pathology (such as ovarian vein thrombosis), or abscess formation, as recommended by the American College of Radiology 1.
- A pelvic ultrasound is the preferred initial imaging modality due to its ability to evaluate for gynecological etiologies of pelvic pain, such as adnexal torsion, tubo-ovarian abscess, and ruptured hemorrhagic cyst.
- CT scan with contrast may be necessary if ultrasound is inconclusive or if other intra-abdominal pathologies are suspected, such as diverticulitis or inflammatory bowel disease, as suggested by the ACR Appropriateness Criteria for left lower quadrant pain-suspected diverticulitis 1.
Differential Diagnosis
The differential diagnosis should include:
- Endometritis
- Urinary tract infection
- Ovarian vein thrombosis
- Wound infection if cesarean delivery occurred
- Constipation
- Non-pregnancy related causes such as diverticulitis or inflammatory bowel disease Prompt consultation with an obstetrician is essential, as postpartum complications can progress rapidly and require timely intervention to prevent serious morbidity. According to the most recent guidelines, CT abdomen and pelvis with IV contrast may be considered if a life-threatening diagnosis is suspected or if ultrasound and MRI are inconclusive 1.
From the Research
Postpartum Abdominal Pain Workup
The workup for a 21-year-old female, 7 days postpartum, presenting with left lower quadrant (LLQ) abdominal pain involves considering various potential causes, including:
- Uterine rupture, especially if there are risk factors such as previous C-sections 2
- Ovarian vein thrombosis (OVT), which can present with lower abdominal and flank pain, fever, tachycardia, and nausea and vomiting 3
- Other less common but important diagnoses, such as uterine perforation, which can be life-threatening 2
- Common causes of acute pelvic pain, including idiopathic pelvic pain, pelvic inflammatory disease, acute appendicitis, ovarian cysts, ectopic pregnancy, and endometriosis 4
Evaluation and Management
Evaluation of postpartum abdominal pain should include:
- A thorough history and physical examination to identify potential causes and risk factors
- Laboratory testing, such as a pregnancy test, and imaging studies, such as ultrasonography or computed tomography, to confirm the diagnosis 4
- Consideration of the patient's symptoms, medical history, and physical examination findings to guide the evaluation and management plan
- Appropriate management, including pain relief and treatment of any underlying conditions, to prevent complications and promote recovery 5, 6
Potential Diagnoses to Consider
Potential diagnoses to consider in a postpartum patient presenting with LLQ abdominal pain include: