Interactive Transcript
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A common indication for imaging
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in the context of pregnancy is
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suspected abdominal pelvic pathology.
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There are numerous potential causes of
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abdominal pain in the pregnant patient,
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both obstetric and non-obstetric.
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Ultrasound remains the first-line imaging
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modality, whether you think the cause
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is obstetric or something more focal,
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such as right upper quadrant pain with
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suspicion for acute biliary pathology.
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CT is indicated in the pregnant patient
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in high-acuity situations, including
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trauma and suspected pulmonary embolism.
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An MRI can be useful for troubleshooting
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or further characterizing findings
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that are detected at initial imaging.
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This is a list of many, but not all, of
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the potential causes of abdominopelvic
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pain and pathology during pregnancy.
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These include gastrointestinal etiologies,
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very commonly acute appendicitis,
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cholecystitis, or pathology involving the
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gallbladder and biliary tree, HELLP syndrome,
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which is hemolysis with elevated liver
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enzymes and low platelets, which does occur
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in pregnant patients, pancreatitis, bowel
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obstruction, and inflammatory bowel disease.
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Genitourinary causes of abdominopelvic
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pain are also fairly common in pregnancy,
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including hydronephrosis of pregnancy,
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which is technically not pathologic, but is
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something you'll see because of mass effect
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of the gravid uterus on the distal ureter.
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Pregnant patients can also get
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obstructing stones or pyelonephritis.
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There are multiple gynecologic causes of
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abdominopelvic pain, including those
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related to the ovaries, such as ovarian
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torsion, ovarian cysts, adnexal masses,
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as well as uterine causes, such as
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fibroids, endometriosis, or mixed
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etiologies, such as tubo-ovarian abscess
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and pelvic inflammatory disease.
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Obstetrical causes of abdominal
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pelvic pain include ectopic pregnancy,
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placentation abnormalities, including
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placenta accreta spectrum, placental
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abruption, and preterm labor.
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Vascular etiologies include pelvic
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congestion syndrome, something that we
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see not infrequently, particularly later
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in pregnancy, and deep venous thrombosis,
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as pregnancy is a hypercoagulable state.
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Finally, it's important to remember that
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pregnant patients are just as susceptible to
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trauma as the general population, but are at
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a higher risk of intimate partner violence.
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