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Pelvic pain in early pregnancy
Last reviewed: 06.07.2025
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The occurrence of pelvic pain in early pregnancy is associated with spontaneous abortion, septic abortion, with a disrupted or progressive ectopic pregnancy, with a ruptured corpus luteum cyst (ovarian cyst at the site of the egg exit). Non-obstetric disorders may be associated with appendicitis, pyelonephritis, nephrolithiasis, musculoskeletal pain, irritable bowel syndrome, growth or degeneration of fibroid tumors and, rarely, with inflammatory diseases of the pelvic organs. Ectopic pregnancy may lead to hemorrhagic shock, septic abortion - to septic shock. Any shock should be treated with intravenous solutions.
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Evaluation of pelvic pain in early pregnancy
The results of the study can suggest the causes of pelvic pain associated with pregnancy. Non-obstetric disorders are assessed as in non-pregnant women.
History and clinical examination
Risk factors for ectopic pregnancy include a previous ectopic pregnancy, a history of sexually transmitted diseases or pelvic inflammatory disease, use of an intrauterine device, previous pelvic surgery (especially on the tubes), and smoking. A criminal abortion or an abortion performed by an inexperienced physician suggests a septic abortion, but even the absence of a history does not rule out this diagnosis. The presence of severe pain, especially with movement, may indicate peritonitis.
Results of a study on some disorders causing pelvic pain associated with early pregnancy
Research result |
Ectopic pregnancy |
Spontaneous abortion |
Septic abortion |
Corpus luteum cyst |
Hemorrhagic shock due to external bleeding |
Y |
N |
N |
N |
Septic shock |
N |
N |
Y |
N |
Peritonitis |
Y |
N |
Y |
Y |
Open cervical canal and parts of the fertilized egg |
N |
Y |
Y |
N |
Purulent vaginal discharge |
N |
N |
Y |
N |
Vaginal bleeding |
Y |
Y |
Y |
N |
Colicky pain |
N (usually) |
Y |
Y (early) |
N |
Tumor of the appendages |
Y |
N |
N |
Y |
History of criminal abortion |
N |
N |
Y |
N |
Y - the test result is general or characteristic; N - the test result is not characteristic. Torn. No rupture or bleeding.
A general examination and examination of the pelvic organs are performed. If the cervical canal is open and areas of the fertilized egg are identified, then a spontaneous abortion can be assumed.
Diagnosis of pelvic pain in early pregnancy
If obstetric causes are suspected, a complete blood count is performed, prothrombin time, partial thromboplastin time, fibrinogen level and usually blood group and Rh factor are determined. If the internal os of the cervix is open and the fertilized egg has exited the uterine cavity, no further examination is performed unless there is a suspicion of septic abortion; in this case, blood is taken for bacteriological examination. If the internal os of the cervix is closed and the fertilized egg is not detected in the cervical canal, an ectopic pregnancy must be excluded; diagnosis begins with a quantitative measurement of beta-hCG, and pelvic ultrasonography is performed. If hemorrhagic shock is not relieved despite initial restoration of fluid volume, a ruptured ectopic pregnancy can be suspected.
Treatment of pelvic pain in early pregnancy
Treatment is aimed at eliminating the underlying pathology. If a disrupted ectopic pregnancy is suspected, urgent laparoscopy or laparotomy must be performed.