Abdominal Pain In Pregnancy

Pregnancy And Non-Pregnancy Related Causes of Abdominal Pain 

Abdominal pain in pregnancy is a common complaint for expectant mothers. The good news is abdominal pain is not necessarily dangerous for pregnant women. The more challenging news is abdominal pain in pregnancy is almost unavoidable.

Hormonal changes, along with the growing womb and stretching ligaments can create discomfort and mild to moderate pain for expectant mothers. In the third trimester, Braxton Hicks contractions can cause more severe abdominal pain in pregnancy. Of course, pregnant women are not immune to non-pregnancy pains. But for the most part, abdominal pain in pregnant women are a normal part of healthy developing pregnancy.

A Timeline of Common Abdominal Pain in Pregnancy 

The causes of pregnancy- and non-pregnancy-related pain in the abdomen can vary depending on how far along the mother is in her pregnancy. 

Early Pregnancy: Conception to 12th Week

The first trimester starts at conception and goes till the end of the twelfth week (about the third month) of pregnancy. This is the most crucial time for the pregnancy as 10 – 20% of confirmed pregnancies end in miscarriage, and 70% of miscarriages take place in the first trimester, according to Medical Daily. Pain in the abdomen early in the pregnancy is often cause for alarm.

Miscarriage 

Miscarriage often starts with the passage of small amount of blood from the vagina, and may be followed later with, or accompanied b, a varying degree of abdominal cramping and lower abdominal pain. Half of the women who experience symptoms of a miscarriage will successfully carry their babies to term (37 weeks).

Ectopic Pregnancy 

Ectopic pregnancy (or tubal pregnancy) is a common condition that happens when a fertilized egg attaches outside the womb, usually in the fallopian tubes. Ectopic pregnancies are dangerous for both the baby and the mother, as the fetus cannot develop outside the uterus and if it progresses, it can cause internal bleeding for the mother.

An ectopic pregnancy causes lower abdominal pain on one side of the abdomen, which may later be followed by vaginal bleeding. Pain can also start on the right or left lower side of the abdomen in the first 5 to 10 weeks of pregnancy. Ectopic pregnancies can be life-threatening if not diagnosed on time.

Gestational Trophoblastic Disease

Gestational Trophoblastic disease occurs when tumours grow inside the uterus and cause the involuntary termination of the pregnancy. Gestational Trophoblastic disease starts in the tissue that would become the placenta, which is how the fetus is nourished during the pregnancy. Gestational Trophoblastic disease causes lower abdominal pain in early pregnancy with bleeding or passage of grape-like materials, and a larger-than-normal uterus.

Hiatus Hernia During Pregnancy

A hernia is the protrusion of an internal organ through a gap in abdominal muscle that likely never fully grows together, or that did not fully close after a previous pregnancy.  Because of the stress endured by the abdominal muscles during pregnancy, women can more easily develop hernias during pregnancies, usually as the result of lifting heavy items, straining during bowel movements, or even from gaining weight. Hernias can often be seen and felt. The dull ache of a hernia will be experienced in the lower abdomen, when the expectant mother moves around, bends over, sneezes or otherwise engages her abdominal muscles.     

Midterm Pregnancy: 13th to 27th Week

Second trimester is the three months in the middle of the pregnancy, and it is typically a time when expectant mothers begin to regain some sense of normalcy. Morning sickness is gone or diminished, the aches and pains of rapid growth have slowed (before they start again in the third trimester). Miscarriages are far less likely to occur in the second trimester than in the first trimester of pregnancy. The causes of abdominal pain during the second trimester of pregnancy are usually due to things like:

Round Ligament Pain

Round ligament pain is caused by the stretching of the ligaments that support the pelvis and the uterus during pregnancy. This stretching causes a dull, dragging lower abdominal ache that spreads to the back. It could also cause a sharp, dragging right or left sided abdominal pain during the second trimester.

Fibroids

A fibroid is the overgrowth of muscle tissue along the walls of the uterus. About 40% of women over the age of 40 develop a uterine fibroid. Fibroid also occur in pregnant women. If a fibroid tumour gets too big for the blood vessels around it to support it, the lack of oxygen and nutrients will cause the fibroid to harden, fill with collagen, and cause severe lower abdominal pain in pregnancy.

Acid Reflux

Acid reflux occurs when the muscle that closes the esophagus when we swallow our food is too weak to close and allows the stomach contents (bile) and stomach acid to push back into the throat. Acid reflux is a condition that commonly plagues pregnant women.  Pregnant women with acid reflux will feel a burning or sharp pain in the upper abdomen behind the breastplate.

Pre-Eclampsia and Eclampsia

Pre-Eclampsia and Eclampsia are life-threatening conditions whereby a mother develops dangerously high blood pressure later in her pregnancy. Eclampsia usually starts after the 20th week of pregnancy and manifests with swelling, high amounts of protein in the urine, and pain in the upper abdomen.  

Polyhydramnios

Polyhydramnios is a condition in which there is too much amniotic fluid around the baby. Polyhydramnios can cause the uterus to be larger than it should be for that age of pregnancy, stretching it and causing abdominal pain during middle to late pregnancy. It can easily be diagnosed with a scan.

Late Pregnancy: 28th to 40th Week

During a woman’s third trimester the conditions that cause abdominal pain late in the pregnancy include:

Preterm Labour

Though less common, the loss of pregnancy can occur in the second trimester. A mother may experience lower cramping abdominal pain in pregnancy at any time. With preterm labour, real labour begins before the 37th week of pregnancy, sometimes before the baby has developed enough to survive outside the womb. The World Health Organization reports that 15 million babies are born preterm annually, and preterm complications are the leading cause of death in children under 5 years of age.  

Braxton Hicks Contraction

Braxton Hicks Contractions are mild to moderate contractions that radiate from the upper and lower abdomen to the back in the second trimester. They are false labour, but the intensity of Braxton Hicks Contractions increase as the pregnancy progresses. Their primary purpose is to prepare the body for labour, but unlike true labour, an expectant mother can usually minimize or eliminate the pain of Braxton Hicks Contractions by changing positions, getting active, lying on her right side, or taking an over-the-counter pain killer.  Read more about Braxton Hicks here.

Placental Abruption or Abprutio Placentae 

Placental abruption occurs when the placenta partially or completely separates from the wall of the uterus during pregnancy. It is often the result of abdominal trauma like a car accident, injury, or violence. Placental abruption is a very serious condition as the placenta is the only way for an unborn fetus to receive the oxygen and nutrients needed to survive. Placental abruption causes severe abdominal pain that radiates to the back, along with vaginal bleeding.

Symphysis Pubis Dysfunction (SPD)

As pregnancy continues and the body prepares for the birth of the baby, the ligaments around the pelvis and hip bones loosen and becomes lax. Sometimes, the weight of the uterus puts excessive pressure on the lax ligament holding the two side of the pelvic bones together in the middle. This causes severe pain in the front of the pelvis, and this pain could spread to the upper thighs and around the genital region and anus, worsened by movement. Women suffering with SPD often walk with what doctors call waddling gait - like the steps of a duck.

For more information common causes of abdominal pain in pregnancy, click here.

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