Women's Healthcare Topics

Abdominal Pain During Pregnancy

Reviewed by James Brann, M.D.

Many women experience lower abdominal pain during the early weeks of pregnancy. There are many reasons for this. For some women occasional or sporadic abdominal discomfort during pregnancy similar to menstrual cramps may simply be a sign that your uterus is preparing to carry your baby through the next nine months of pregnancy.

Abdominal pain accompanied by other symptoms however, including chills, fever, spotting or bleeding may be a sign that something more serious is happening.

Many women will experience occasional bouts of lower abdominal pain during pregnancy. While frightening at best abdominal pain during pregnancy is usually a normal and harmless condition. Lower abdominal pain during pregnancy can sometimes suggest a more serious problem however, so it is important you consult with your health care provider if you have any concerns regarding abdominal pain during pregnancy.

The evaluation of abdominal pain during pregnancy is similar to the evaluation of stomach pain when you are not pregnant, but the evaluation has additional challenges. For example, your physician has to consider the normal changes that occur specific to pregnancy that can cause abdominal pain, while always keeping in mind the well being of your baby and your gestational age.

Abdominal pain in pregnancy is a common complaint and can be due to a number of normal pregnancy changes, such as the enlarging uterus, the baby's position or movement, Braxton-Hicks contractions (ie, false labor), and the support ligaments to the uterus called the round ligaments (round ligament pain).

Abdominal pain that comes on suddenly, persistent, and severe, and associated with other problems such as nausea, vomiting, vaginal bleeding, or contractions suggests the pain is not due to normal pregnancy changes but some other problem.

bladder infection, or cystitis
Video: bladder infection in pregnancy.

Normal Changes in Pregnancy that Cause Abdominal Pain

The enlarging uterus as it raises out of the pelvis places pressures on the lower back and abdomen and produces pain. The enlarged uterus may also compress the ureter, (the tube between the bladder and the kidney) making it difficult for urine to pass down the ureter causing intermittent severe lower abdominal pain. This pain can mimic the pain associated with passing a kidney stone, or bladder infection.

The ligaments that hold the uterus in place can also be stretched from the enlarging uterus causing sudden onset of sharp lower abdominal pain. This is called round ligament pain.

Digestive problems during pregnancy
Video: Burping, Acid Reflux, and Bloating.

In addition, the hormonal changes during pregnancy can decrease lower esophageal sphincter tone (esophageal reflux) causing symptoms of indigestion and dyspepsia.

The normal increases in progesterone seen in pregnancy can influence many organs. The progesterone will decrease the peristalsis of the bowel and cause constipation and pain. The gallbladder is also affected by the increased pregnancy hormones. The gallbladder cannot secrete its digestive enzymes correctly with the increasing pregnancy hormones, thus slowing down the gallbladder function and this can mimic the pain associated with gallstones.

All of these are just a few of the normal pregnancy changes that can result in abdominal pain.

Pregnancy Health Section

Pregnancy Related Causes of Abdominal Pain

  • Miscarriage - Occasionally lower abdominal pain is a sign of a pending miscarriage. Symptoms of miscarriage typically include bleeding that is light or heavy and menstrual like cramping that gradually increases in intensity. Other women experience back pain. If you confirm a pregnancy then experience spotting, bleeding and cramping, be sure to contact your doctor right away.

  • Placental abruption — The separation of the placenta from the uterine wall prematurely can cause bleeding and severe lower abdominal pain in pregnancy. Placental abruption not only results in severe abdomen pain, but fetal distress for the unborn child. Delivery is immediately needed to avoid fetal death and serve maternal hemorrhage.

  • Uterine rupture — Uterine rupture can cause abdominal pain in pregnancy. Most uterine ruptures occur in childbirth while having a vaginal birth after cesarean section (VBAC). The previous cesarean section scar on the uterus opens up and allows the head of the baby to float in the abdomen. Not only is an uterine rupture associated with abdominal pain, it causes fetal distress, and heavy vaginal bleeding leading to shock.

  • Ectopic Pregnancy - This is a serious condition that occurs in early pregnancy when a fertilized egg attaches outside of a woman's uterus. Normally the egg attaches to a fallopian tube. Typically this condition is caught in the first few weeks of pregnancy. When not treated an ectopic pregnancy is very serious and may result in rupture of the fallopian tubes. Signs and symptoms of an ectopic pregnancy include spotting, abdominal pain and tenderness, bleeding, back pain , shoulder pain, dizziness or faintness. If you suspect an ectopic pregnancy contact your doctor immediately!

  • Severe Preeclampsia and HELLP syndrome — Severe preeclampsia results in upper right and mid quadrant abdominal pain. Preeclampsia refers to a syndrome characterized by high blood pressure, headache and protein in your urine. Severe preeclampsia will cause swelling around the liver which causes the upper abdominal pain. The HELLP syndrome is a more severe form of preeclampsia that's most common presentation is severe pain in the upper abdomen.

  • Amniotic Fluid Infection — Infection of the amniotic fluid and sac the baby sits in can cause fever, abdominal pain, contractions and labor. It is commonly seen with premature rupture of the membranes.

  • Preterm Labor - Some women experience lower abdominal pain or cramping further along in their pregnancy. This may be a sign of premature labor. Preterm labor is typically characterized by regular abdominal contractions that start dilating and effacing the cervix. You may experience vaginal discharge that is a bloody mucous accompanied by cramping, or low back pain. Be sure you contact your doctor immediately to rule out premature labor. In many cases early labor can be stopped effectively allowing mothers to carry their baby to term.

Non-Pregnancy Related Causes of Lower Abdominal Pain

  • Acute appendicitis — Appendicitis is the most common cause of right quadrant, lower abdominal pain that requires surgery during pregnancy. The most symptom of appendicitis, is low grade fever and right lower quadrant pain.

  • Gallbladder disease —Pregnancy does increase the risk of developing gallstones. When the gallstones interfere with the gallbladder function the result is gallbladder disease. The symptoms of a poorly functioning gallbladder is a deep and gnawing pain that is intermittently sharp and severe. The abdominal pain is located in the right upper quadrant and may come and go.

  • Bowel obstruction — As the uterus increases in size during pregnancy the chance of bowel obstruction also increases. Previous scar tissue (adhesions) are the most common reason for bowel obstruction in pregnancy. Bowel obstruction will cause crampy abdominal pain with vomiting. Previous surgeries are the leading cause of adhesions that result in bowel obstructions .

  • Inflammatory bowel disease — The abdomen pain associated with inflammatory bowel disease is in the lower quadrants and usually associated with loose, bloody, mucous stool.

  • Pancreatitis — Rarely an inflamed pancreas can cause persistent upper abdominal pain. This pain typically radiates straight through to the back.

    Diverticulitis — When pouches or sacs in the wall of the colon become inflamed ( Diverticulitis) this results in lower abdominal pain. Diverticulitis is also associated with loose and bloody stools.

  • Perforated ulcer —Despite peptic ulcer disease getting better in pregnancy, sometimes a peptic ulcer will perforate. The abdomen pain will evolve over the first few hours after perforation. The pain will become very severe.

  • Nephrolithiasis — Kidney stones usually present in the second and third trimesters of pregnancy. The pain is in the flank and then travels to the lower abdomen. Blood is also present in the urine in most cases. Usually a kidney infection is associated with the stones.

  • Trauma — Motor vehicle accidents are the cause of two-thirds of trauma that causes abdominal pain in pregnancy. The pain can be associated with either blunt or penetrating trauma.

  • Sickle cell crisis — The vasomotor crisis seen with sickle cell disease can causes severe abdominal pain. The pain is difficult to distinguish from appendicitis or gallbladder disease.

  • Pneumonia — The lower lobe pneumonias commonly cause abdominal pain syndromes, specifically the right side. Abdominal pain can be the sole symptom in pregnancy with a lower lobe pneumonia.

  • Gastroenteritis — Severe abdominal pain results from maternal gastroenteritis and inflammation of the abdominal lymph nodes (mesenteric adenitis).

  • Thrombosis — Blood clots in the pelvic veins, liver and abdominal cavity (mesenteric veins) can cause poorly localized abdominal pain.

The good news is most women will experience mild abdominal discomfort throughout their pregnancy that occasionally occurs from the uterus stretching, from gas or even from constipation.

If you are having lower abdomenal pain, remember when in doubt contact your health care provider immediately. Your doctor can help identify the cause of your abdominal pain and put your mind at ease.


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