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Pelvic pain in early pregnancy
Last reviewed: 23.04.2024
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The appearance of pelvic pain in the early stages of pregnancy is associated with spontaneous abortion, septic abortion, with an impaired or progressive ectopic pregnancy, with a rupture of the cyst of the yellow body (ovarian cyst in the egg exit site). Non-obstetric disorders can be associated with appendicitis, pyelonephritis, nephrolithiasis, musculoskeletal pain, colon irritation syndrome, growth or degeneration of fibroid tumors, and, rarely, inflammatory diseases of the pelvic organs. Ectopic pregnancy can lead to hemorrhagic shock, septic abortion - to septic shock. Any shock should be treated with intravenous injection of solutions.
[1]
Assessment of pelvic pain in early pregnancy
When receiving the results of the study, one can assume the causes of pelvic pain associated with pregnancy. Non-obstetric disorders are evaluated, as in non-pregnant.
Anamnesis and clinical examination
Risk factors for ectopic pregnancy are the presence of a previous ectopic pregnancy, a history of data on sexually transmitted diseases or pelvic inflammatory diseases, the use of an intrauterine device, previous pelvic surgery (especially on tubes), and smoking. Criminal abortion or abortion by an inexperienced doctor presupposes the presence of a septic abortion, but even the absence of an anamnesis does not exclude this diagnosis. The presence of severe pain, especially when moving, may indicate peritonitis.
Results of the study for some disorders of pelvic pain associated with early pregnancy
|
Result of research |
Ectopic pregnancy |
Spontaneous abortion |
Septic abortion |
Yellow body 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 fetal egg |
N |
Y |
Y |
N |
|
Purulent discharge from the vagina |
N |
N |
Y |
N |
|
Vaginal bleeding |
Y |
Y |
Y |
N |
|
Colic pain |
N (usually) |
Y |
Y (early) |
N |
|
Tumor of the appendages |
Y |
N |
N |
Y |
|
Anamnesis of criminal abortion |
N |
N |
Y |
N |
Y - the result of the study is general or characteristic; N - the result of the study is not typical. Torn. There is no rupture and bleeding.
A general examination and examination of the pelvic organs is carried out. If the cervical canal is uncovered and the areas of the fetal egg are identified, then we can assume a spontaneous abortion.
Diagnosis of pelvic pain in early pregnancy
When suspected of obstetric causes, a general blood test is performed, prothrombin time, partial thromboplastin time, fibrinogen level and usually the blood group and its Rh factor are determined. If the inner cervix is open and the fetal egg is released from the uterus, no further examination is performed if there is no suspicion of septic abortion; in this case, blood is taken for bacteriological examination. If the inner cervix is closed and the fetal egg in the cervical canal is not detected, ectopic pregnancy should be excluded; Diagnosis begins with a quantitative measurement of beta-hCG, and pelvic ultrasonography is performed. If the hemorrhagic shock does not stop, despite the initial recovery of the fluid volume, then it is possible to suspect an impaired ectopic pregnancy.
Treatment of pelvic pain in early pregnancy
Treatment is aimed at eliminating the underlying pathology. If a suspected ectopic pregnancy is suspected, urgent laparoscopy or laparotomy should be performed.