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Some Causes and Features of Pelvic Pain During Early Pregnancy

Some Causes and Features of Pelvic Pain During Early Pregnancy

Cause

Common Features*

Diagnostic Approach†,‡

Pregnancy-related (obstetric) disorders

Abdominal or pelvic pain that

  • Is often sudden and constant

  • Begins in a specific spot

  • May or may not be accompanied by vaginal bleeding

If the ectopic pregnancy has ruptured, possibly fainting, light-headedness, or a racing heart

A blood test to measure a hormone produced by the placenta (human chorionic gonadotropin, or hCG)

Ultrasonography of the pelvis

Sometimes laparoscopy (insertion of a viewing tube through an incision in the abdomen) or laparotomy (surgery involving an incision into the abdomen)

  • Has occurred or is occurring (spontaneous abortion)

  • May occur (threatened abortion)

Crampy pain in the pelvis and often throughout the abdomen

Often vaginal bleeding, sometimes with passage of tissue from the pregnancy

Sometimes a doctor’s examination alone

Usually tests as for ectopic pregnancy

Usually in women who have had an abortion (often done by untrained practitioners or by the women themselves)

Ultrasonography of the pelvis

Cultures of a sample taken from the cervix (the lower part of the uterus)

A crampy or burning sensation in the lower abdomen, pelvis, and/or lower back

Sometimes ultrasonography of the pelvis

Gynecologic disorders unrelated to the pregnancy

Pelvic pain that

  • Begins suddenly

  • Is often accompanied by nausea, vomiting, and fever

Sometimes vaginal bleeding

Ultrasonography of the pelvis

Pelvic pain that

  • Begins suddenly

  • May be cramping and is often mild if the ovary untwists on its own

Often nausea or vomiting

Doppler ultrasonography (to evaluate blood flow to and from the ovary)

Sometimes laparoscopy or laparotomy

Rupture of a corpus luteum cyst (which develops in the structure that releases the egg after the egg is released)

Abdominal or pelvic pain that

  • Occurs in a specific spot

  • Sometimes resembles pain due to a twisted ovary

  • Usually begins suddenly

Vaginal bleeding

Ultrasonography of the pelvis

Sometimes laparoscopy or laparotomy

Pelvic pain that

  • Is continuous

  • Usually develops gradually

  • Usually occurs on both sides

A vaginal discharge that contains pus

Sometimes fever or chills

More common among women who have sexual intercourse with new partners and do not use condoms or diaphragms

Microbiologic testing, such as polymerase chain reaction (PCR) or culture, of a sample taken from the cervix

Sometimes ultrasonography of the pelvis

Other disorders

Usually continuous pain and tenderness in the lower right part of the abdomen

Possibly pain in a different location (for example, higher in the abdomen) or a different kind of pain (milder and crampy) from that in people who are not pregnant

Sometimes a doctor’s examination alone

Sometimes ultrasonography of the pelvis and abdomen

Sometimes CT if ultrasonography is inconclusive

Discomfort felt in the area over the pubic bone

Often burning during urination, an urge to urinate often (frequency), and a need to urinate immediately (urgency)

Sometimes blood in urine

Urine tests (urinalysis) and culture

Pain that

  • May be crampy or constant

  • Can occur in various locations

Often diarrhea that sometimes contains mucus or blood

Usually in women known to have the disease

Sometimes endoscopy of the upper digestive tract, lower digestive tract (sigmoidoscopy or colonoscopy), or both

Cramping pain that comes and goes

Vomiting

No bowel movements or gas (flatulence)

A swollen abdomen

Usually in women who have had abdominal surgery

Sometimes a doctor’s examination alone

Sometimes x-rays of the abdomen, ultrasonography of the pelvis and abdomen, and/or CT of the abdomen and pelvis

Usually vomiting and diarrhea

Sometimes a doctor's examination alone

Sometimes stool analysis and culture

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing.

‡ A urine pregnancy test is typically done if women have had only a home pregnancy test. Because an ectopic pregnancy can be very dangerous, tests are done to look for ectopic pregnancy in most pregnant women with pelvic pain, unless symptoms clearly point to another disorder (such as gastroenteritis).

CT = computed tomography; MRI = magnetic resonance imaging.