ODOBGYNDECODED

← All presentations

Abdominal pain in pregnancy

Bleeding in pregnancyAbdominal pain in pregnancyReduced fetal movementsHeadache + high BP in pregnancy/postpartumFever in pregnancy/postpartumDyspnoea in pregnancyVaginal discharge / cervicitisAcute pelvic pain (non-pregnant)Postmenopausal bleedingInfertility evaluation
Immediate red flags:
  • Peritonism/rigidity
  • Hypotension/tachycardia
  • Positive hCG + unilateral pain (ectopic!)
  • Fever + RUQ (HELLP/cholangitis)
Urgent workup:
  • hCG FIRST in reproductive age
  • CBC, LFTs, lipase, urinalysis
  • TVS/TAS US
  • CXR/ECG when upper abdomen unclear

Structured differential — act in priority order

PriorityConditionKey featuresAction
CANNOT MISS
Ectopic pregnancy
Amenorrhoea+pain+bleeding triad
Ectopic module →
CANNOT MISS
Abruption
Uterine tenderness+contractions
abruption pathway →
COMMON
Appendicitis
Migration to RIF displaced upward with gestation
Surgical review; imaging MRI/US-first
CANNOT MISS
Ovarian torsion
Acute vomiting+mass
Emergency laparoscopy →
COMMON
Pyelonephritis
Loin->groin, rigors
UTI module →
CONSIDER
HELLP epigastric
HTN+platelets/LFTs
HELLP module →
CONSIDER
Round ligament/obstetric benign
Self-limited, afebrile
Reassure after exclusions

First moves

  1. Obstetric exclusion scan before surgical labels