Is abdominal pain common in early pregnancy?

Abdominal Pain in Early Pregnancy

Abdominal pain is very common in early pregnancy, with various physiological and pathological causes requiring careful evaluation to distinguish between normal pregnancy changes and potentially serious complications.

Normal Physiological Causes

• Uterine stretching and ligament pain (round ligament pain) are common causes of mild to moderate abdominal discomfort in early pregnancy 1
• Gastrointestinal changes during pregnancy, including decreased motility and increased pressure from the growing uterus, can cause discomfort 1
• Constipation related to hormonal changes and pressure on the bowel can manifest as abdominal pain 1

Concerning Pathological Causes

Obstetric Causes

• Ectopic pregnancy is a critical diagnosis to consider in any woman with abdominal pain in early pregnancy, especially with vaginal bleeding 1
• Threatened or incomplete abortion (miscarriage) commonly presents with cramping abdominal pain and vaginal bleeding 1
• Placental abnormalities including early abruption can cause abdominal pain 1

Non-Obstetric Causes

• Appendicitis is the most common cause of abdominal pain requiring emergency surgery in pregnant patients 1
• Urinary tract infections and urolithiasis are common causes of abdominal pain during pregnancy 1
• Ovarian torsion and adnexal masses can cause acute abdominal pain 1
• Acute cholecystitis and pancreatitis may present differently in pregnancy due to anatomical changes 1

Clinical Presentation Challenges

• The location of pain may not follow typical patterns due to anatomical changes of pregnancy - for example, appendicitis pain may not present in the classic right lower quadrant location 1
• Upper abdominal pain complicates up to 46% of pregnancies after certain bariatric surgical procedures 1
• Normal physiological symptoms of pregnancy (nausea, vomiting, constipation) can mask or mimic pathological conditions 2
• Anatomical and physiological changes of pregnancy can change and diminish the expected clinical features used to diagnose abdominal conditions 2

Diagnostic Approach

Initial Assessment

• Vital signs assessment is crucial - tachycardia is a significant predictor of serious complications in pregnant patients 1
• Laboratory studies should include complete blood count, urinalysis, and pregnancy tests 1
• The combination of fever, tachycardia, and tachypnea should raise immediate concern for serious complications 1

Imaging Considerations

• Ultrasound is the primary imaging modality for evaluating abdominal pain in pregnancy 1
• MRI is recommended as the next step following ultrasound when additional imaging is needed, as it avoids radiation exposure 1, 3
• CT should be avoided when possible due to radiation concerns, but should not be withheld in life-threatening situations 1

Management Principles

• Early involvement of both obstetric and surgical specialists is recommended for non-obstetric causes of abdominal pain 4
• Prompt diagnosis and treatment are essential as delays can lead to adverse outcomes for both mother and fetus 4
• For post-bariatric surgery patients, internal herniation should be considered with any abdominal pain, with maternal and fetal deaths reported when treatment is delayed beyond 48 hours 1

Red Flags Requiring Immediate Attention

• Severe pain with hemodynamic instability (tachycardia, hypotension) 1
• Peritoneal signs (rebound tenderness, guarding) despite these being potentially less pronounced in pregnancy 2
• Fever with abdominal pain suggests infection requiring prompt evaluation 1
• Vaginal bleeding with abdominal pain may indicate ectopic pregnancy or threatened abortion 1