women s health issues
Pelvic Pain During Early Pregnancy
Evaluation of Pelvic Pain in Early Pregnancy
If a pregnant woman has pelvic or abdominal pain, a doctor will evaluate whether this is caused by normal changes of pregnancy or if there is a problem. If there is sudden, very severe pain in the lower abdomen or pelvis, doctors must quickly try to determine whether prompt surgery is required—as is the case when the cause is a ruptured ectopic pregnancy or appendicitis. In pregnant women with pelvic pain, the following symptoms are cause for concern: Vaginal Bleeding During Early Pregnancy None Fever and chills, particularly if accompanied by pain with urination, upper back (flank) pain, or a vaginal discharge that contains pus Pain that is severe and is made worse with movement Fainting, light-headedness, or a rapid heart rate—symptoms that suggest very low blood pressure Women with warning signsshould see a doctor immediately. Women without warning signsshould try to see a doctor within a day or so if they have pain or burning during urination or pain that interferes with daily activities. Women with only mild discomfort and no other symptoms should call the doctor. The doctor can help them decide whether and how quickly they need to be seen. To determine whether emergency surgery is needed, doctors first check the woman's blood pressure and temperature and ask about key symptoms, such as vaginal bleeding. Doctors then ask about other symptoms and the medical history. They also do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table). Doctors ask about the pain: Whether it begins suddenly or gradually Whether it occurs in a specific spot or is more widespread Whether moving or changing positions worsens the pain Whether it is crampy and whether it is constant or comes and goes Doctors also ask about the following: Other symptoms, such as vaginal bleeding, vaginal discharge, a need to urinate often or urgently, vomiting, diarrhea, and constipation Previous pregnancy-related events (obstetric history), including past pregnancies, miscarriages, and intentional terminations of pregnancy (induced abortions) for medical or other reasons Risk factors for miscarriage and ectopic pregnancy The physical examination focuses on the pelvic examination (examination of the external and internal reproductive organs and sometimes the rectum). Doctors also gently press on the abdomen to see whether pressing causes any pain. A pregnancy test using a urine sample is usually done. If the pregnancy test is positive, ultrasonography of the pelvis is done to confirm that the pregnancy is normally located―in the uterus―rather than somewhere else (an Ectopic Pregnancy ). For this test, a handheld ultrasound device is placed on the abdomen, inside the vagina, or both. If a pregnancy is very early, it is sometimes not possible to confirm if the pregnancy is in the uterus. Blood tests are usually done. If a woman has vaginal bleeding, testing usually includes a complete blood cell count and blood type plus Hemolytic Disease of the Fetus and Newborn (positive or negative), in case the woman needs a transfusion. Knowing Rh status also helps doctors prevent problems in subsequent pregnancies. If doctors suspect an ectopic pregnancy, testing also includes a blood test to measure a hormone produced by the placenta early during pregnancy (human chorionic gonadotropin, or hCG). If symptoms (such as very low blood pressure or a rapid heart rate) suggest that an ectopic pregnancy may have ruptured, blood tests are done to determine whether the woman's blood can clot normally. The doctor does other tests depending on which disorders are suspected. Doppler ultrasonography, which shows the direction and speed of blood flow, helps doctors identify a twisted ovary, which can cut off the ovary’s blood supply. Other tests can include cultures of blood, urine, or a discharge from the vagina and urine tests (urinalysis) to check for infections. If pain is persistently troublesome and the cause remains unknown, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to directly view the uterus, fallopian tubes, and ovaries to further evaluate the cause of the pain. Rarely, a larger incision (a procedure called laparotomy) is required. 