Acute Abdomen in Pregnancy- A Descriptive Study

Abstract

BACKGROUND Acute abdomen during pregnancy is often worrisome for an obstetrician owing to the diagnostic and management challenges. A strong index of suspicion, clinical expertise and a multidisciplinary approach can go a long way to tackle such cases. The aim of this study is to analyse the presenting clinical features and the causes of acute pain abdomen during pregnancy and the management of such cases. MATERIALS AND METHODS A descriptive study was performed on 55 pregnant women presenting with acute pain abdomen admitted in Silchar Medical College and Hospital between July 2016 and June 2018. A detailed history and a thorough clinical examination was done. Women with labour pains were excluded from the study. The necessary investigations apart from the routine antenatal tests were carried out. Ultrasonography was performed in all. MRI was done when feasible or when diagnosis was unclear. Case management was individualised, and surgical and medical team involvement was made whenever needed. Surgical intervention was taken if indicated. All women were followed up. Data was analysed with Microsoft Excel. RESULTS 41.8%, 32.7% and 25.5% of the women were of the age group of 25 to 31 years, 18 to 24 years and 32 to 38 years respectively. 49.1% were Muslims, 20% were Hindus and 14.5% were Christians. 34.5% were booked cases. 81.8% were from rural areas. 36.4% of patients each presented with pain in the second and third trimester of pregnancy. The presenting symptoms were pain (100%), diminished appetite (45.5%), nausea (32.7%), bleeding per vagina (27.3%), increased urinary frequency (18.2%), backache (18.2%), shortness of breath (7.3%), diarrhoea (3.6%) and constipation (3.6%). In 89.1% women, pain was of less than 24 hours duration. 45.5%, 40% and 14.5% came with diffuse, lower and upper abdominal pain respectively. 87.3% complained of continuous dull pain, while 10.9% had intermittent, colicky pain. Anaemia (54.5%) and hypotension (49.1%) were the common associated findings. 29 (52.7%) cases were diagnosed to have an obstetrical cause of pain which included ectopic pregnancy (27.6%), miscarriage (20.7%), molar gestation (17.2%), ruptured uterus (17.2%), abruptio placentae (10.3%) and acute polyhydramnios (6.9%). In 26 (47.3%) cases the cause of pain abdomen was non-obstetrical which included acute appendicitis (19.2%), acute cholecystitis (15.4%), ureteric colic (15.4%), acute urinary tract infection (11.5%), acute pancreatitis (7.7%), intestinal obstruction (7.7%), acute peptic ulcer (7.7%), torsion of ovarian tumour (7.7%), blunt trauma with splenic rupture (3.8%) and red degeneration of uterine fibroid (3.8%). 82.8% of the women with obstetrical cause required surgical management. Amongst the 26 cases with non-obstetrical origin of pain, 8 (30.8%) underwent surgery-laparotomy (5) and laparoscopy (3). Significantly, higher number of surgeries were carried out in the second trimester (p < 0.05). The complications among women with non-obstetrical abdominal pain were-wound infection and preterm labour, amongst tho...