Chapter 19  Other causes of abdominal pain in early pregnancy  Urinary tract infection

 -Lower urinary tract infection is common in pregnancy  - increased risk of ascending infection.  - Acute pyelonephritis occurs in 1–2% of pregnant women.  -The clinical features include :  -fever,

 loin tenderness and urinary frequency.  - Treatment :intravenous antibiotics, fluids and adequate analgesia.

Urolithiasis  -Urinary calculi in pregnancy  -sudden onset abdominal pain  - associated with urinary tract infection and haematuria.  -Ultrasound :unilateral hydronephrosis or a calcified area are suggestive of renal calculi.

 The management intravenous fluids, antibiotics and effective analgesia.  - If a calculus is large enough to cause obstruction then surgery may be required

Appendicitis  There is no increase in incidence during pregnancy but mortality is higher.  During pregnancy the caecum and appendix are displaced upwards and to the right with advancing gestation.  The pain is less well localized and tenderness, rebound and guarding less obvious.

 This leads to delay in diagnosis and treatment and an increased incidence of perforation (15–20% of cases)  peritonitis and sepsis. When perforation occurs, maternal and fetal mortalityincrease  surgical treatment is essential,accomplished by laproscopy

Cholecystitis  -sudden onset of right upper quadrant or epigastric  -colicky pain with associated nausea, vomiting and fever.  -Jaundice is uncommon.  - The diagnosis ;  -clinical picture  -biochemical tests

 - the presence of stones in the biliary tree on ultrasound scan.  - The treatment :  -antibiotics  - adequate analgesia and fluids.  -Surgery is indicated during pregnancy where there is associated pancreatitis or recurrent episodes but otherwise is deferred until after the puerperium

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