Causes of Upper Stomach Pain in Pregnancy

Introduction:

As the baby develops, the belly tends to enlarge, stretching the skin and squeezing internal organs, especially in the upper abdomen, which can be painful. The third trimester is when this pain is more prevalent. Due to the previously indicated cause, this pain will typically be normal, but it may occasionally be caused by underlying pathology like a cyst, which manifests early in pregnancy. One need not be afraid of this kind of pain. Knowing the history and the results of the investigations, a doctor can always determine the cause.

When Is Upper Abdominal Pain Considered Normal During Pregnancy?

• The uterus, generally a pelvic organ, transforms into an intra-abdominal organ during week 12 of pregnancy. Because of the mechanical muscle stretching and distension brought on by the growing fetus, the uterus enlarges even more.

• The uterus' blood vessels increase due to rising demands. Organs are moving out of the way to make room for the expanding uterus. The intestines, stomach, and omentum travel laterally and upward, except the colon. This pain may sometimes hamper the diagnosis of peritonitis or be misinterpreted as urolithiasis.

• Due to hormone interactions, pregnancy causes changes in the body's endocrine, circulatory, metabolic, gastrointestinal, musculoskeletal, renal, respiratory, and behavioral systems. Delayed stomach emptying, gastric reflux, bloating, nausea, and vomiting are typical GI symptoms. In addition, they have constipation, increased sodium and water absorption, and high aldosterone levels, especially during the third trimester.

• A detailed grasp of anatomical variation might facilitate an early diagnosis. In addition, early diagnosis identification and timely surgical intervention enhanced perinatal outcomes.

What Are the Known Causes of Abdominal Pain During Pregnancy?

• Obstetric Causes (Pregnancy-Related):

  • Ectopic pregnancy.

  • Abruption.

  • HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets).

  • Uterine rupture.

  • Uterine and ovarian torsion.

  • Abdominal pregnancy.

• Non-obstetric Causes (Non-Pregnancy-Related):

  • Acute appendicitis.

  • Gallbladder disease.

  • Acute pancreatitis.

  • Intestinal obstruction.

• Causes Outside the Abdomen:

  • Peptic Ulcer - Typically caused by germs or excessive use of painkillers.

  • Urolithiasis - Nephrolithiasis, is the formation of renal stones within the kidneys. As these stones leave the renal pelvis and travel into the remaining portions of the urinary system including ureters, urethra, and blabber they are known as urolithiasis.

  • Intra-Abdominal Hemorrhage - Abdominal bleeding due to a non-traumatic and non-iatrogenic cause

  • Gastroesophageal Reflux Disease - A condition where the stomach's contents spill into the food pipe from the stomach

1. Ectopic Pregnancy: The impregnation of the fertilized egg outside the uterus, usually in the fallopian tube, is called an ectopic pregnancy. A fallopian tube is a tube that links the uterus to the ovary. Unfortunately, an ectopic pregnancy cannot be saved. Although the patient's pregnancy tests will show a positive result, she will experience severe stomach pain, occasionally vaginal bleeding, a shoulder ache, urinating discomfort, and fecal excretion.

2. Abruption: In abruption, the placenta entirely or partially separates from the uterus, which results in insufficient oxygen and nutrients reaching the fetus. The patient will have abdominal pain and vaginal bleeding during abruption. Even a small abruption must be regularly monitored because it is easy to become a complete one. Preterm birth, stillbirth, and delayed fetal growth are the complications of abruption. Early delivery, either by induction or C-section, is the only treatment for this condition.

3. HELLP Syndrome: It is a rare complication in pregnancy. It shares many of the same symptoms as preeclampsia. Blurred vision, lethargy, edema, and pain in the upper abdomen region are common symptoms of HELLP syndrome. HELLP syndrome patients frequently require early delivery of their child. Preeclampsia is severe hypertension during pregnancy, which is a very lethal complication of pregnancy by itself.

4. Uterine Rupture: The tear in the wall of the uterus is called uterine rupture. The effort to deliver a baby vaginally after a C-section frequently results in a uterus rupture. It can be full (all three uterine walls) or just partially full (does not involve all three walls of the uterus). Urinary blood and severe upper abdominal discomfort are the early indicators of uterine rupture. The only treatment for this illness is typically a hysterectomy, the surgical removal of the uterus.

5. Uterine and Ovarian Torsion: When an ovary bends around the ligaments holding it in place, it is said to have undergone ovarian torsion, which eventually stops blood flow to the ovaries and fallopian tube, resulting in discomfort, nausea, and vomiting. When the ovary is not getting enough blood, ovarian torsion can result in excruciating pain and other symptoms. If the condition is left untreated for an extended period, it may result in necrosis of the ovary, ovary loss, and, in rare instances, infertility. One ovary is often affected by ovarian torsion, also known as adnexal torsion.

The term "torsion" refers to the rotation of the uterus during pregnancy that is greater than 45 degrees around its long axis. Every age group in the reproductive cycle, every parity, and every stage of pregnancy are all characterized by uterine torsion. The most frequent signs of uterine torsion are urinary and intestinal symptoms, birth obstruction, abdominal discomfort, vaginal bleeding, shock, and symptoms of the bladder and cervix. Early in the pregnancy, the uterus is immediately laparotomized (an abdominal cavity incision made during surgery to access the internal organs and aid in problem identification), detorsioned (procedure to correct torsion), and, if possible, additional surgery is performed to address potential causes. In addition, a C-section is performed while the baby is close to term or during labor.

6. Abdominal Pregnancy: It is a rare form of ectopic pregnancy that results in the death of both the mother and the fetus. If the placenta separates from the abdomen, the mother may experience significant internal bleeding and abdominal discomfort while the fetus experiences a reduction in oxygen, nutrients, and blood flow. Unfortunately, even an abdominal pregnancy cannot be spared, much like other ectopic pregnancies.

What Are Pregnancy and Non-pregnancy Related Non-obstetric Causes?

• Acute appendicitis and pancreatitis are high-risk pregnancy problems that can cause severe abdominal pain, nausea, vomiting, and stillbirth. However, preventing fetal death by early management of this illness is achievable.

• Throughout the third trimester of pregnancy, it is more common to develop intestinal obstruction and gall bladder illness. Gallstones are caused by hormonal abnormalities that raise cholesterol levels, whereas intestinal obstruction can have many different causes, such as adhesions, tumors, and other things.

Conclusion:

Acute stomach pain can be brought on by obstetric and non-obstetric sources alike. However, life-threatening illnesses may not manifest in the expected ways. Therefore, a thorough awareness of the anatomy and physiological changes in pregnancy, a complete clinical evaluation, a full comprehension of the safe limits of radiological diagnostics, and a multidisciplinary approach are required for the quick diagnosis and treatment of acute abdomen in pregnancy.