1 / 18

Abdominal pain complicated 3 rd trimester pregnancy

HKCEM College Tutorial. Abdominal pain complicated 3 rd trimester pregnancy. Author Dr. Paulin Ng revised by Dr. WONG ho tung Oct, 2013. Triage note. Female, 30 G3P2 Gestation: 30 week C/O: diarrhea and abd pain for 4 hours Afebrile BP 120/80 mmHg; P 90/min. Triage Category IV.

cirila
Télécharger la présentation

Abdominal pain complicated 3 rd trimester pregnancy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HKCEM College Tutorial Abdominal pain complicated 3rd trimester pregnancy Author Dr. Paulin Ng revised by Dr. WONG ho tung Oct, 2013

  2. Triage note • Female, 30 • G3P2 • Gestation: 30 week • C/O: diarrhea and abd pain for 4 hours • Afebrile • BP 120/80 mmHg; P 90/min Triage Category IV

  3. What are the DDx?

  4. DDx • OBGyn causes • Preterm labor, Preeclampsia, Abruptio placenta, Traction of round ligament • Surgical causes • acute appendicitis, cholecystitis (hydrop), renal colic • Medical causes • GE, pyelonephritis, hepatitis

  5. Now take a targeted history The nature of pain:PQRST Review GI, GU systems Antenatal history

  6. History • Uneventful antenatal history • Lower abd pain for 4 hours • Irregular, colicky, no radiation • Passing yellowish loose stool twice • No Nausea and Vomit • No group involvement or travel history • No PV bleeding or leaking • No dysuria or loin pain

  7. Abdomen Uterus-fetus Review of systems Now, a focused physical exam

  8. Physical Findings • Maternal • Afebrile, BP stable • Abdominal exam. • Soft, Mild tenderness over lower abd • No guarding or rebound tenderness • PR: no pelvic tenderness • Uterus_Fetal • Uterus palpation for several min to determine contraction • Fundal height • Fetal lie • Doptone fetal heart rate: 140/min Potential Pitfalls

  9. Potential pitfalls of Abd exam in pregnancy • Abnormal location of pain e.g. appendicitis with pain in RUQ • Peritoneal sign less obvious due to chronic stretching of abdomen • Bowel colic difficult to differentiate from uterine contraction

  10. Blood Urine Ultrasound What investigations would you like to request?

  11. Investigations • Blood work: • Hb (n), WCC (n) • Urinalysis • Protein (-), wbc (-) • USG • Fetal assessment: single viable fetus • Evidence of acute cholecystitis, dilated renal calyces, abruptio placenta: nil

  12. What are the management? • Bed rest • Monitor maternal and fetal vitals • Serial abdominal exam in observation ward • Cardiotocography (CTG) monitoring if preterm labor is suspected

  13. What is the Disposition? • Admit surgery • If there is evidence of acute abdomen • Admit Obstetric • If preterm labor or abruptio placenta is suspected • If abdominal pain persists after observation • Discharge Home • If pain subsides • Counsel on the risk and S/S of preterm labor • Seek medical care if pain recurs

  14. Progress • The patient had increasing frequency of abdominal pain compatible with uterine contraction in the “Observation” ward • She was admitted to Obstetric for further CTG monitoring and administration of tocolytics What is preterm labour? How does it present?

  15. Preterm Labour • < 37 weeks • regular uterine contraction+ cervical effacement; • contractions > 5-8/ hr • Nonspecific presentations • LBP • cramp • change in vaginal discharge

  16. Dx of Preterm labor • High index of suspicion • Presentations: • Uterine contraction • Backache • Bleeding • Leaking of fluid • Increased vaginal discharge

  17. Summary We have covered: • DDx of abd pain complicated preg • Important Dx to be R/O: surgical causes, pretern labor and concealed abruptio placenta • Evaluation of preg patient with abd pain • High index of suspicion in diagnosing preterm labor • CTG monitoring is advisable in suspected preterm labor

  18. Thank You

More Related