Women of reproductive age who are experiencing abdominal pain should generally check if they are pregnant before taking any other action, because pain and discomfort in the abdominal region can have very different causes in pregnant women than in non-pregnant women.
A missed menstruation is usually the first indication of pregnancy for women, but hCG urine tests can come back positive as soon as one week following conception. The blastula, early embryo, implants into the lining of the uterus seven to 10 days after fertilization, and human chorionic gonadotropin, hCG, will be produced as soon as this happens. A pregnancy test is the quickest way to confirm or rule out pregnancy when you have abdominal pain.
Does your hCG urine test show that you are not pregnant? Then premenstrual pain, Pelvic Inflammatory Disease, urinary tract infections, ovulation pain and ovarian cysts are possible causes of abdominal pain.
If your pregnancy test is positive, then ectopic pregnancy, uterine fibroids, miscarriage and urinary tract infections come into the picture.
An ectopic pregnancy is a pregnancy in which the fertilized egg implants outside of the uterine cavity, most commonly in the fallopian tubes but also sometimes in the ovaries, abdominal cavity, or on the broad ligament. Clinical features include cramping and lower abdominal pain (on the side of the affected tube), vaginal bleeding, and a positive pregnancy test. An ultrasound will confirm or rule out an ectopic pregnancy.
Early detection of an ectopic pregnancy is vital, because these pregnancies cannot continue -- unless you are talking about a pregnancy in the abdominal cavity, which is still potentially life-threatening. An ectopic pregnancy almost always ends in abortion. A tubal pregnancy can easily lead to the rupture of the affected fallopian tube, which causes hemorrhage and is immediately life-threatening. The definitive treatment of an ectopic pregnancy is laparotomy/laparoscopy. If the sac cannot be milked out at the fimbrial end of the tube, the whole tube may have to be removed (salpingectomy).
Women with fibroids may also experience abdominal pain during pregnancy, usually within the second trimester. Fibroids can undergo what is known as "red degeneration", which means hemorrhage occurs within the center of the fibroid. This is not a life-threatening condition. Uterine fibroids can also prevent pregnancy in the first place (two to three percent of female fertility problems is due to fibroids). After labor and delivery, fibroids may cause postpartum hemorrhage.
Miscarriage also causes abdominal cramping and pain, because of the contractions of the uterus. There are three main types of miscarriage. A complete miscarriage means that the miscarriage starts and completes naturally, though bleeding can last for up to two weeks. Tissues are not completely expelled in a partial miscarriage, though the patient will bleed and her cervix will be open. Vaginal prostaglandin tablets and evacuation of retained tissues may be needed. In a missed miscarriage, the fetus passes away without the onset of a miscarriage. This is usually detected incidentally and will require the same treatment as a partial miscarriage.
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