Differential Diagnosis for Abdominal Pain in Pregnancy

When considering abdominal pain in pregnancy, it's crucial to approach the diagnosis systematically to ensure that both common and potentially life-threatening conditions are identified and managed appropriately. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Urinary Tract Infection (UTI): Given the frequency of urinary tract infections during pregnancy due to physiological changes, such as ureteral dilation and urinary stasis, UTI is a common cause of abdominal pain. Symptoms can include dysuria, frequency, and suprapubic pain.

• Other Likely Diagnoses

  • Braxton Hicks Contractions: As the pregnancy advances, these practice contractions can cause abdominal pain or discomfort, often feeling like a tightening or hardening of the uterus.
  • Round Ligament Pain: This occurs as the ligaments that support the uterus stretch, causing sharp pains or a dull ache in the abdomen, often on one side.
  • Constipation: Pregnancy hormones can slow down bowel movements, leading to constipation, which can cause abdominal pain or discomfort.
  • Gastrointestinal Issues: Conditions like gastroesophageal reflux disease (GERD), gastritis, or intestinal obstruction can cause abdominal pain and are not uncommon in pregnancy.

• Do Not Miss Diagnoses

  • Ectopic Pregnancy: Although less common, an ectopic pregnancy is a life-threatening condition where the embryo implants outside the uterus, often causing severe abdominal pain and vaginal bleeding.
  • Placental Abruption: This condition involves the placenta separating from the uterus, leading to abdominal pain, vaginal bleeding, and potentially severe complications for both mother and fetus.
  • Preeclampsia: Characterized by high blood pressure and often accompanied by protein in the urine, preeclampsia can cause abdominal pain, especially in the upper abdomen, and is a significant risk to both mother and fetus.
  • Appendicitis: Although the diagnosis can be challenging due to the upward displacement of the appendix during pregnancy, appendicitis requires prompt surgical intervention to prevent perforation and peritonitis.

• Rare Diagnoses

  • Ovarian Torsion: While rare, ovarian torsion can occur during pregnancy, causing severe, sudden-onset abdominal pain, often on one side.
  • Uterine Rupture: This is a rare but catastrophic event, usually occurring in women with a previous uterine scar (e.g., from a cesarean section), causing severe abdominal pain and potentially life-threatening complications.
  • Hepatic Rupture or Hematoma: Associated with severe preeclampsia or HELLP syndrome, hepatic rupture is a rare but potentially fatal condition causing abdominal pain.

Each of these conditions requires careful consideration based on the patient's symptoms, medical history, and physical examination findings to ensure timely and appropriate management.