Acute abdominal pain in pregnancy

Some degree of abdominal pain is virtually physiologic in pregnancy, for which reason these women will commonly present to the emergency physician for clinical evaluation. Appendicitis is the commonest nonobstetric surgical malady complicating pregnancy; however, its clinical presentation may resemble several other surgical as well as medical entities reviewed in this article. The clinical evaluation of these patients is generally confounded because the symptoms typical of these illnesses are common to pregnancy itself, and the physical examination of the abdomen is hampered by the pregnant state. Nevertheless, prompt clinical diagnosis and surgical intervention when indicated is necessary to minimize maternal and especially fetal mortality. The general reluctance to use conventional radiographic study of these patients must be dismissed whenever the physician is confronted with severely ill or unstable patients. Whenever diagnosis is uncertain, liberal use of surgical and obstetric consultants is warranted.