Differential Diagnosis for 28 Weeks Pregnant Woman with Sudden Abdominal Pain
- Single most likely diagnosis:
- Preterm labor: The description of the pain as a continuous, intense pressure similar to a bad period cramp, and the fact that it has been gradually increasing throughout the day, is consistent with preterm labor. The relief experienced while sitting in water could be due to the relaxation and buoyancy effect of water, which might temporarily alleviate some of the discomfort associated with uterine contractions.
- Other Likely diagnoses:
- Urinary tract infection (UTI): Although the pain is described as being in the front abdomen, UTIs can cause significant discomfort that might be perceived as abdominal pain. The continuous nature of the pain and the fact that it's like a bad period cramp could also fit with a severe UTI, especially if there's associated dysuria or frequency.
- Round ligament pain: As the uterus expands, the round ligaments stretch, which can cause sharp pains or a dull ache in the abdomen. However, this typically presents as more intermittent pain and might not fully account for the continuous, increasing nature of the pain described.
- Do Not Miss diagnoses:
- Placental abruption: This is a life-threatening condition where the placenta separates from the uterus. It can cause severe, continuous abdominal pain and is a medical emergency. The fact that the pain is severe (8/10) and continuous raises concern for this condition.
- Uterine rupture: Although rare, especially in the absence of previous uterine surgery, a rupture can cause severe abdominal pain and is an emergency. The description of intense pressure could be consistent with this diagnosis.
- Ovarian torsion: This condition involves the twisting of an ovary, which can cause severe, sudden pain. It's less common in pregnancy but can occur, especially with the displacement of organs due to the enlarging uterus.
- Rare diagnoses:
- Appendicitis: Although appendicitis can occur during pregnancy, the location of the pain (front abdomen) and its description are not typical for appendicitis, which usually presents with right lower quadrant pain. However, the appendix can be displaced upward during pregnancy, potentially altering the typical pain location.
- Pancreatitis: This condition causes severe abdominal pain, usually in the upper abdomen, and can be associated with nausea and vomiting. It's less common in pregnancy but can occur, especially with conditions like gallstones, which are more prevalent during pregnancy due to bile stasis.