From the Guidelines
The workup for a 14-week pregnant woman with abdominal pain should begin with a thorough history and physical examination, focusing on both obstetric and non-obstetric causes, and initial imaging should include an obstetric ultrasound, with MRI or ultrasound recommended if appendicitis is suspected, as stated by Vasileiou et al in the EAST multicenter study 1.
Initial Evaluation
The initial evaluation should include:
- Vital signs
- Abdominal examination
- Pelvic examination if indicated
- Laboratory tests, such as:
- Complete blood count
- Comprehensive metabolic panel
- Urinalysis
- Urine culture
Imaging
Imaging studies should be selected based on the clinical presentation and suspected diagnosis.
- An obstetric ultrasound is essential to confirm fetal viability, placental location, and rule out ectopic pregnancy or miscarriage, as suggested by the ACR Appropriateness Criteria 1.
- If appendicitis is suspected, an MRI or ultrasound is recommended, as reported by Vasileiou et al in the EAST multicenter study 1.
- Additional imaging may include renal ultrasound if urinary tract issues are suspected, with MRI preferred over CT scan to avoid radiation exposure.
Further Testing
Depending on symptoms, further testing may include:
- Stool studies for gastrointestinal concerns
- Vaginal cultures for infectious causes Throughout the workup, fetal monitoring should be performed as appropriate for gestational age.
Considerations
This comprehensive approach is necessary because pregnancy can complicate the presentation of common conditions, and certain pregnancy-specific complications like round ligament pain, preeclampsia, or placental abruption must be considered alongside non-obstetric causes such as appendicitis, urinary tract infections, or ovarian pathology, as discussed in the ACR Appropriateness Criteria 1 and the EAST multicenter study 1.
From the Research
Diagnostic Approach
The diagnostic approach for a 14-week pregnant female with abdominal pain involves a combination of clinical evaluation, laboratory tests, and imaging studies. The primary goal is to identify the cause of the pain while minimizing the risk of harm to the fetus 2.
- Clinical evaluation: A thorough medical history, physical examination, and vital sign assessment are essential to determine the severity of the pain and potential causes.
- Laboratory tests: Blood tests, such as complete blood count, blood type, and beta human chorionic gonadotropin (β-hCG) levels, may be ordered to help diagnose potential causes of abdominal pain 3.
- Imaging studies:
- Ultrasound: Remains the primary imaging modality for evaluating the pregnant abdomen due to its safety, availability, and lack of ionizing radiation 2, 4.
- Magnetic Resonance Imaging (MRI): May be used when ultrasound is inconclusive or to further evaluate potential causes of abdominal pain 2, 4.
- Computed Tomography (CT): Typically reserved for life-threatening situations or traumatic injuries, as it involves ionizing radiation 4.
Potential Causes
Abdominal pain in a 14-week pregnant female can be caused by various factors, including:
- Obstetric causes: Ectopic pregnancy, miscarriage, or placental abruption 3.
- Non-obstetric causes: Appendicitis, gallbladder disease, or urinary tract infections 5, 6.
- Gynecologic causes: Ovarian torsion or ovarian cyst rupture 2.
Management
The management of abdominal pain in a 14-week pregnant female depends on the underlying cause. Accurate diagnosis and timely treatment are crucial to prevent adverse outcomes for both the mother and fetus 5, 6.