The causes upper and generalized abdominal pain are similar to those in non-pregnant patients.

Pelvic pain are common in early pregnancy and may accompany heavy or light conditions. Some disorders that cause abdominal pain can also lead to vaginal bleeding. The bleeding can cause some of these diseases (eg. As ruptured ectopic pregnancy, ruptured hemorrhagic corpus luteum cyst) be massive, occasionally has a haemorrhagic shock. The causes upper and generalized abdominal pain are similar to those in non-pregnant patients. Etiology causes of pelvic pain in early pregnancy (see Table: Causes of pelvic pain in early pregnancy) may be pregnant Depending Gynecologic, pregnancy independent non gynecological Sometimes no specific cause is found. The most common pregnancy-related cause spontaneous abortion (threatening, starting, incomplete, complete, septic or behavior), the most common serious pregnancy-related cause is Ruptured Ectopic Pregnancy The pregnancy independent, gynecological causes include adnexal torsion, which makes demands more common during pregnancy because during pregnancy the luteum enlarges the ovaries, thereby reducing the risk for torsion of the ovary increases around the stem. Some common non-gynecological causes include various disorders of the gastrointestinal and genitourinary tract: viral gastroenteritis irritable bowel syndrome appendicitis Inflammatory bowel disease urinary tract infection nephrolithiasis pelvic pain in late pregnancy can result from birth or numerous other, pregnancy independent pelvic pain. Causes of pelvic pain in early pregnancy cause Suspicion Results Diagnostic procedure pregnancy-related diseases ectopic abdominal or pelvic pain, often suddenly, localized and constant (not spasmodically), with or without vaginal bleeding Closed cervix No fetal heart tones may hemodynamic instability in ruptured ectopic quantitative ?-hCG determining blood type and Rh blood typing pelvic sonography Spontaneous abortion (threatening, starting, incomplete, complete, behave) Cramping, diffuse abdominal pain, often dependent with vaginal bleeding Open or closed cervix (the type of abortion s. Causes of vaginal bleeding in early pregnancy) investigation as ectopic septic abortion Usually obviously of previous instrumental intervention on the uterus or induced abortion (often illegal or self-induced) fever, chills, persistent abdominal or pelvic pain with purulent vaginal discharge open cervix investigation as Extrauteringraviditätt plus. cervical cultures Normal changes in pregnancy, including expansion and growth of the uterus during early pregnancy Cramping or burning sensations in the abdomen, pelvis and / or back Investigation as ectopic pregnancy diagnosis of exclusion pregnancy Independent gynecological diseases Myomdegeneration sudden onset of abdominal pain, often with nausea, vomiting and fever Uncommon vaginal bleeding investigation as ectopic adnexal (ovarian) twist sudden onset of localized abdominal pain, which may be colicky and often slightly when the twist spontaneously repaired Common nausea, vomiting investigation as ectopic zzg l. Doppler sonography Ruptured corpus luteum cyst Localized abdominal or pelvic pain, sometimes similar to adnexal torsion Vaginal bleeding usually suddenly inserting investigation plus as ectopic pregnancy. Doppler sonography Pelvic inflammatory disease (rare during pregnancy) Cervical discharge, significant tenderness adnexal investigation cervical cultures plus as ectopic pregnancy. Not gynecological diseases Appendicitis usually persistent pain, tenderness occasionally atypical localization (eg. As right upper quadrant) or character (mild, spasmodic, no Peritonealzeichen) compared with pain in non-pregnant patients investigation as ectopic plus. Cervical cultures ultrasonography of the lower abdomen / abdomen if necessary CT Inflammatory in unclear ultrasound findings UTI suprapubic discomfort, often with the involvement of the urinary bladder (z. B. burning, frequent urination, urinary urgency) urinalysis and urine culture bowel disease Changing pain (cramping or persistent) at various locations, often with diarrhea, occasionally slimy or bloody usually known history Clinical examination Occasionally endoscopic intestinal obstruction colic, vomiting, no bowel movements or flatulence Exaggerated, tympanisches Abdom Usually s of previous surgical intervention to the abdomen (caused adhesions) or occasionally incarcerated hernia that is determined during the investigation study plus as ectopic pregnancy. cervical cultures sonography of the lower abdomen / abdomen if necessary CT in unclear ultrasound findings gastroenteritis usually vomiting, diarrhea No Peritonealzeichen Clinical examination * ?-hCG = ?-subunit of human chorionic gonadotropin. Clarification should (ruptured or z. B. not ruptured ectopic pregnancy, septic abortion, appendicitis) potentially difficult treatable causes are ruled out. The history of the current history of disease should the pregnancy and parity of the patient and the start of the pain (sudden or gradual), localization (localized or diffuse) and include the character (varicose or colic). In a previous attempted illegal abortion suspected septic abortion, but even without such a history, this diagnosis is not excluded. In reviewing the Organysteme should be paid to genito-urinary and gastrointestinal symptoms that indicate a cause. Important urogenital symptoms are vaginal bleeding (ectopic or abortion), syncope or Beinahesynkopen (ectopic pregnancy), frequent urination, urinary urgency or dysuria (urinary tract infection) and vaginal discharge and previous unprotected sex (pelvic inflammatory disease). Important gastrointestinal symptoms are diarrhea (gastroenteritis, inflammatory bowel disease or irritable bowel syndrome), vomiting (numerous diseases, including gastroenteritis and intestinal obstruction) and constipation (intestinal obstruction, irritable bowel syndrome or functional disorder). The history should include disease, which is known to you cause pelvic pain (eg. As inflammatory bowel disease, irritable bowel syndrome, nephrolithiasis, ectopic pregnancy, spontaneous abortion). Risk factors for these diseases should be identified. Among the risk factors for ectopic pregnancy Sexually transmitted diseases or pelvic inflammatory disease history of cigarette smoking use include intrauterine age> 35 years Preceding surgery on the abdomen (especially tubal surgery) Application fertility-enhancing drugs or assisted reproductive techniques Past ectopic pregnancy (most importantly) Multiple sexual partners vaginal douches Among the risk factors for spontaneous abortion include age> 35 years Back Reclining spontaneous abortion cigarette smoking drugs (eg. as cocaine, alcohol, high amounts of caffeine) uterine abnormalities (eg. as leiomyoma, adhesions) belonging to the risk factors for bowel obstruction s Back Reclining surgery on the abdomen hernia Physical examination The physical examination begins with a review of vital signs, especially in fever and signs of hypovolemia (hypotension, tachycardia). The investigation focuses on the abdomen and the lower abdomen. The abdomen is scanned with respect to pressure sensitivity, Peritonealzeichen (rebound tenderness, hardened abdominal wall, guarding) and uterine size and percussed on bloat. The fetal heart tones are checked using a Doppler probe. The pelvic exam includes an inspection of the cervix to discharge, dilation and bleeding. From a sample of any effluent a culture is applied. Blood or blood clots in the birth canal are carefully removed. By bimanual examination is to Portio sliding pain, adnexal masses or tenderness and uterine size untersucht.Warnzeichen The following findings are of particular importance: Hemodynamic instability (hypotension and / or tachycardia) syncope or Beinahesynkope Peritonealzeichen (rebound tenderness, hardened abdominal wall, guarding) fever, chills and purulent vaginal discharge vaginal bleeding interpretation of the findings Specific findings give clues to the causes of pelvic pain, but are not always diagnostic proving (see table: causes of pelvic pain in early pregnancy). For all women with pelvic pain in early pregnancy is the most serious cause an ectopic pregnancy must be excluded, regardless of other findings. Independent pregnancy causes of pelvic pain (eg. As acute appendicitis) must always be considered and examined as in non-pregnant women. As with all patients signs of peritoneal irritation are (z. B. focal tenderness, guarding, rebound tenderness, hardened abdominal wall) concern. Common causes include appendicitis, ruptured ectopic and rare ruptured ovarian cyst. However, the absence of peritoneal irritation does not exclude such diseases, so must be thought highly of her. A vaginal bleeding that is accompanied by pain, leaves a spontaneous abortion or ectopic suspect. An open cervix or through the cervix passing therethrough fabric is a clear indication of an incipient, complete or incomplete abortion. Fever, chills and purulent vaginal discharge point to a septic abortion out (especially in patients with vorausgegangenem instrumental intervention on the uterus or illegally attempted termination of pregnancy). Pelvic inflammatory disease are rare during pregnancy, but can vorkommen.Tests When a pregnancy-related cause of pelvic pain is suspected, should be a quantitative ?-hCG measurement, a blood count, blood grouping and Rh typing. If the patient hemodynamically unstable (with hypotension and / or sustained tachycardia), the blood should be determined and tested cross fibrinogen, fibrin degradation products and PT / PTT. Beck ultrasound is performed to confirm an ectopic pregnancy. However, and sonography should be postponed in the hemodynamically unstable patient with a positive pregnancy test, because either one ectopic pregnancy or spontaneous abortion with bleeding is very likely. Both transabdominal and transvaginal ultrasound should be performed if necessary. The uterus is empty and is not a tissue depressed, an ectopic pregnancy is suspected. in Doppler ultrasound when a lack of or reduced blood flow can be seen in the adnexa, an adnexal (ovarian) is suspected torsion. However, this finding is not always present as a spontaneous Detorsion may occur. Treatment The treatment depends on the particular cause. Ectopic pregnancy is a confirmed and not ruptured, frequently may be considered methotrexate or surgical salpingotomy or salpingectomy be performed. A ruptured ectopic pregnancy or oozing is treated by immediate laparoscopy or laparotomy. Treatment of spontaneous abortion depends on the type of abortion and the hemodynamic stability of the patient. Threatening abortions be treated conservatively with oral analgesics. Threatening, incomplete or restrained abortions are treated medically or surgically with misoprostol by emptying the uterus by dilation and curettage. Septic abortions are plus by emptying the uterus. I.v. Antibiotic therapy. Women with Rh-negative blood should be obtained from vaginal bleeding and ectopic pregnancy, Rh0 (D) immunoglobulin. Ruptured luteal cysts and degeneration of a uterine myoma be treated conservatively with oral analgesics. The treatment of adnexal torsion is done surgically: manual Detorsion at vital ovary; Oophorectomy or salpingectomy in infarcted and non-viable ovary. Summary doctors should always draw a ectopic pregnancy into account. Independent pregnancy causes should be considered; an acute abdomen may develop during pregnancy. Is it possible to demonstrate any clear, pregnancy independent cause, usually an ultrasound is required. Septic abortion is presumed when a previous instrumental intervention on the uterus or an induced abortion is present. In vaginal bleeding of Rh status is determined, and all women with Rh-negative blood receive Rh0 (D) immunoglobulin.


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