Imaging the pregnant patient with acute abdominal pain

Pregnant patients frequently present with non-specific abdominal pain requiring medical attention. It is important to identify those with an ‘acute abdomen’ requiring surgical intervention and equally not expose mother and baby to the risks of surgery if this is not indicated. Clinical assessment is difficult in pregnant females due to a number of factors related to a normal pregnancy including vague symptoms such as nausea and vomiting, heartburn and constipation, non-specific leukocystosis that can mimic or mask an inflammatory response and, perhaps most importantly, displacement of abdominal and pelvic structures from their normal location by the increasing size of the gravid uterus. The latter not only confounds the clinical presentation, as the displaced structures can result in pain in ‘atypical’ sites, but also limits physical examination – particularly at the later stages of pregnancy.

Imaging therefore plays a particularly important role in determining the aetiology of acute pelvic pain in pregnant patients.

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