The article shows the main causes of functional and organic abdominal pain and its specific types during pregnancy. The author presents the tactics of patient management, the peculiarities of the interpretation of laboratory data in case of suspected acute surgical pathology and “alarm symptoms” in case of abdominal pain in pregnant women. She emphasized the importance of imaging techniques in the differential diagnosis of acute abdomen syndrome in the gestational period. Article also substantiates safety and the need for magnetic resonance imaging in patients with persistent abdominal pain. It discusses a clinical case of paralytic intestinal obstruction in a pregnant woman. It analyzes the drug therapy for abdominal pain, taking into account the prevalence of the expected benefit to the mother over the potential risk to the fetus. The author demonstrates that the management of abdominal pain relies on a conservative approach due to the lack of evidence base on the safety of drugs for the fetus and clinical guidelines for the management of pregnant women with abdominal pathology. Author also emphasizes the need for legal registration of the appointment of magnetic resonance imaging and computed tomography, as well as off-label pharmacotherapy the instructions during gestation.