Key content Abdominal pain in pregnancy is common, with a differential diagnosis that can encompass obstetric, surgical and medical conditions. Presentation of common surgical problems can be atypical in pregnancy, potentially delaying diagnosis. Surgical causes of abdominal pain to consider in pregnancy include appendicitis, cholecystitis, bowel obstruction, ureteric obstruction, pancreatitis and aneurysm rupture, most commonly involving the splenic artery. The management of surgical conditions in pregnancy requires continuing evaluation and potential modification to balance the medical, surgical and obstetric challenges. Management of the pregnant woman with a surgical cause of abdominal pain requires collaborative, multispecialty practice to optimise care of the mother and baby. Learning objectives To highlight the differential diagnoses of abdominal pain in pregnancy. To develop a structured assessment process for pregnant women with abdominal pain. To update the obstetrician on the priorities of surgical management for abdominal pain in pregnancy. Ethical issues Evaluating the risks of surgical interventions on the mother and baby with the high potential for premature delivery.
The number of women opting for elective caesarean sections has steadily increased within the last few years. Our aim is to assess whether the Enhanced Recovery Programme (ERP), a national programme aiming to improve the outcome of elective caesareans by active patient participation, could lead to quicker recoveries and earlier discharges whilst maintaining the best standard of care. Method A paper-based questionnaire was distributed to the women opting for an Elective Caesarean from 03/09/2012 to 20/11/2012. The questionnaire aimed to assess the ERP by questioning patients’ timing of eating, drinking and mobilisation post-operatively, attendance to the STOP discharge meeting, time of catheter removal and discharge time. Results The majority had their first meal within 2 hours, or 4–6 hours, with the rest being 6+ hours. Most of the women had their catheter removed on time. The majority were unaware of the STOP discharge meeting and so did not attend. The majority were discharged on the 2nd day. Conclusion The study revealed that only about a quarter of patients are able to go home on the 1st day after the Caesarean, while more left on the 2nd day. Only very few had their evening meal whilst seated and only a third attended the STOP Discharge meeting. Both of these should be aimed to be increased under guidance of the ERP. Based on these results, the study shows a need for further ERP adherence to assist recovery of women following a Caesarean section.
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