Differential Diagnosis for Periumbilical Pain in Pregnant Women

• Single Most Likely Diagnosis
  • Gastrointestinal issues (e.g., constipation, gastroesophageal reflux disease (GERD)): These conditions are common in pregnancy due to hormonal changes and pressure from the expanding uterus on the stomach and intestines, leading to periumbilical pain.
• Other Likely Diagnoses
  • Urinary tract infections (UTIs): Pregnancy increases the risk of UTIs, which can cause abdominal pain, including periumbilical pain, due to the proximity of the uterus to the bladder and ureters.
  • Preterm labor: Abdominal pain, including periumbilical pain, can be a symptom of preterm labor, especially if accompanied by regular uterine contractions.
  • Placental abruption: Although more commonly associated with vaginal bleeding, placental abruption can cause abdominal pain, which might be perceived as periumbilical.
• Do Not Miss Diagnoses
  • Ectopic pregnancy: Although ectopic pregnancy typically presents with more severe, sharp, and lateralized pain, it can occasionally cause more generalized or periumbilical pain and is a life-threatening condition if not promptly diagnosed.
  • Appendicitis: Appendicitis can present with periumbilical pain that later localizes to the right lower quadrant. In pregnancy, the appendix can be displaced upward, potentially leading to atypical presentations.
  • Ureteral stones: Kidney stones can cause severe pain (renal colic) that might be referred to the periumbilical area, especially if a stone is obstructing the ureter.
• Rare Diagnoses
  • Ovarian torsion: This condition, although rare, can cause severe, sudden-onset abdominal pain, which might be perceived as periumbilical, especially if the torsion involves structures near the umbilicus.
  • Mesenteric ischemia: A rare but serious condition where blood flow to the intestines is compromised, potentially causing severe abdominal pain, including periumbilical pain, especially in the context of a hypercoagulable state associated with pregnancy.