Advertisement

Acute Abdominal Pain in Pregnant Patients

  • Gabriele MasselliEmail author
  • Martina Derme
  • Gianfranco Gualdi
Chapter

Abstract

Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Prompt diagnosis and treatment are crucial for the well-being of the mother and the fetus, and imaging is often required to clarify the clinical picture. Ultrasound (US) remains the primary imaging modality for the pregnant abdomen and pelvis because of its availability, portability, and absence of ionizing radiation. US can often be used to elucidate the cause of abdominal and pelvic pain, particularly if the pain is due to an obstetric or gynecologic abnormality. However, evaluation of the bowel, pancreas, ureters, and mesenteric vasculature may be limited on US because of patient body habitus, a small field of view, and the presence of overlying structures, especially in the later stages of pregnancy. Magnetic resonance imaging (MRI) has been shown to be highly useful in the diagnosis of acute gynecological and obstetric disorders, and particularly in the setting of an acute abdomen during pregnancy. MRI is often used when US is inconclusive. Computed tomography (CT) is the imaging examination of choice when there is a life-threatening situation, and in patients with trauma, when a rapid diagnosis is required, and US is not diagnostic.

Keywords

Acute abdominal pain Pregnancy Ultrasound Computed tomography Magnetic resonance imaging 

References

  1. 1.
    The Royal College of Obstetricians and Gynaecologists (RCOG). Diagnosis and management of ectopic pregnancy (Green-top Guideline No. 21). https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg21/. Published: 04/11/2016
  2. 2.
    Moini A, Hosseini R, Jahangiri N, Shiva M, Akhoond MR. Risk factors for ectopic pregnancy: a case-control study. J Res Med Sci. 2014;19:844–9.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Parker VL, Srinivas M. Non-tubal ectopic pregnancy. Arch Gynecol Obstet. 2016;294:19–27.CrossRefGoogle Scholar
  4. 4.
    Brown DL, Doubilet PM. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med. 1994;13:259–66.CrossRefGoogle Scholar
  5. 5.
    Masselli G, Brunelli R, Monti R, et al. Imaging for acute pelvic pain in pregnancy. Insights Imaging. 2014;5:165–81.CrossRefGoogle Scholar
  6. 6.
    Masselli G, Derme M, Laghi F, Framarino-dei-Malatesta M, Gualdi G. Evaluating the acute abdomen in the pregnant patient. Radiol Clin North Am. 2015;53:1309–25.CrossRefGoogle Scholar
  7. 7.
    Takahashi A, Takahama J, Marugami N, et al. Ectopic pregnancy: MRI findings and clinical utility. Abdom Imaging. 2013;38:844–50.CrossRefGoogle Scholar
  8. 8.
    Leunen K, Hall DR, Odendaal HJ, Grove D. The profile and complications of women with placental abruption and intrauterine death. J Trop Pediatr. 2003;49:231–4.CrossRefGoogle Scholar
  9. 9.
    Hruska KM, Coughlin BF, Coggins AA, Wiczyk HP. MRI diagnosis of spontaneous uterine rupture of an unscarred uterus. Emerg Radiol. 2006;12:186–8.CrossRefGoogle Scholar
  10. 10.
    Juglard R, Rimbot A, Marty A, et al. Bowel obstruction in pregnancy: value of Single Shot Fast Spin Echo MR sequence (SS-FSE). J Radiol. 2003;84(12 Pt 1):1986–8.PubMedGoogle Scholar
  11. 11.
    Harris RD, Cho C, Wells WA. Sonography of the placenta with emphasis on pathological correlation. Semin Ultrasound CT MR. 1996;17:66–89.CrossRefGoogle Scholar
  12. 12.
    Jaffe MH, Schoen WC, Silver TM, Bowerman RA, Stuck KJ. Sonography of abruptio placentae. Am J Roentgenol. 1981;137:1049–54.CrossRefGoogle Scholar
  13. 13.
    Yeo L, Ananth C, Vintzileos A. Placenta abruption. In: Sciarra J, editor. Gynecology and obstetrics. Hagerstown: Lippincott Williams & Wilkins; 2014.Google Scholar
  14. 14.
    Nyberg DA, Cyr DR, Mack LA, Wilson DA, Shuman WP. Sonographic spectrum of placental abruption. AJR Am J Roentgenol. 1987;148:161–4.CrossRefGoogle Scholar
  15. 15.
    Masselli G, Brunelli R, Di Tola M, Anceschi M, Gualdi G. MR imaging in the evaluation of placental abruption: correlation with sonographic findings. Radiology. 2011;259:222–30.CrossRefGoogle Scholar
  16. 16.
    Atlas SW, Thulborn KR. Intracranial hemorrhage. In: Atlas SW, editor. Magnetic resonance imaging of the brain and of the spine. 4th ed. Lippincott Williams & Wilkins: Philadelphia; 2009. p. 644–94.Google Scholar
  17. 17.
    Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192:1458–61.CrossRefGoogle Scholar
  18. 18.
    Comstock CH, Love JJ Jr, Bronsteen RA, et al. Sonographic detection of placenta accrete in the second and third trimesters of pregnancy. Am J Obstet Gynecol. 2004;190:1135–40.CrossRefGoogle Scholar
  19. 19.
    Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG. 2014;121:171–81.CrossRefGoogle Scholar
  20. 20.
    Masselli G, Brunelli R, Casciani E, et al. Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound. Eur Radiol. 2008;18:1292–9.CrossRefGoogle Scholar
  21. 21.
    Masselli G, Gualdi G. MR imaging of the placenta: what a radiologist should know. Abdom Imaging. 2013;38:573–87.CrossRefGoogle Scholar
  22. 22.
    Lim PS, Greenberg M, Edelson MI, Bell KA, Edmonds PR, Mackey AM. Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study. Am J Roentgenol. 2011;197:1506–13.CrossRefGoogle Scholar
  23. 23.
    Derman AY, Nikac V, Haberman S, Zelenko N, Ophsa O, Flyer M. MRI of placenta accreta: a new imaging perspective. Am J Roentgenol. 2011;197:1514–21.CrossRefGoogle Scholar
  24. 24.
    Gardeil F, Daly S, Turner MJ. Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol. 1994;56:107–10.CrossRefGoogle Scholar
  25. 25.
    Masselli G, Brunelli R, Casciani E, et al. Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdom Imaging. 2011;36:596–603.CrossRefGoogle Scholar
  26. 26.
    Cengiz H, Kaya C, Ekin M, Yeşil A, Yaşar L. Management of incidental adnexal masses on caesarean section. Niger Med J. 2012;53:132–4.CrossRefGoogle Scholar
  27. 27.
    Anthoulakis C, Nikoloudis N. Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: a systematic review. Gynecol Oncol. 2014;132:661–8.CrossRefGoogle Scholar
  28. 28.
    Yacobozzi M, Nguyen D, Rakita D. Adnexal masses in pregnancy. Semin Ultrasound CT MR. 2012;33:55–64.CrossRefGoogle Scholar
  29. 29.
    Yuk JS, Shin JY, Park WI, Kim DW, Shin JW, Lee JH. Association between pregnancy and adnexal torsion: a population-based, matched case-control study. Medicine (Baltimore). 2016;95:e3861.CrossRefGoogle Scholar
  30. 30.
    Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 2014;21:179–87.CrossRefGoogle Scholar
  31. 31.
    Chiou SY, Lev-Toaff AS, Masuda E, Feld RI, Bergin D. Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging. J Ultrasound Med. 2007;26:1289–301.CrossRefGoogle Scholar
  32. 32.
    Rothmund R, Taran FA, Boeer B, et al. Surgical and conservative management of symptomatic leiomyomas during pregnancy: a retrospective pilot study. Geburtshilfe Frauenheilkd. 2013;73:330–4.CrossRefGoogle Scholar
  33. 33.
    Muram D, Gillieson M, Walters JH. Myomas of the uterus in pregnancy: ultrasonographic follow-up. Am J Obstet Gynecol. 1980;138:16–9.CrossRefGoogle Scholar
  34. 34.
    Masselli G, Brunelli R, Parasassi T, Perrone G, Gualdi G. Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound. Eur Radiol. 2011;21:1841–9.CrossRefGoogle Scholar
  35. 35.
    Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics. 1999;19:1179–97.CrossRefGoogle Scholar
  36. 36.
    Semins MJ, Matlaga BR. Management of urolithiasis in pregnancy. Int J Womens Health. 2013;5:599–604.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E. MRI imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics. 2012;32:317–34.CrossRefGoogle Scholar
  38. 38.
    Masselli G, Derme M, Laghi F, et al. Imaging of stone disease in pregnancy. Abdom Imaging. 2013;38:1409–14.CrossRefGoogle Scholar
  39. 39.
    Masselli G, Derme M, Bernieri MG, et al. Stone disease in pregnancy: imaging-guided therapy. Insights Imaging. 2014;5:691–6.CrossRefGoogle Scholar
  40. 40.
    Gilo NB, Amini D, Landy HJ. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol. 2009;52:586–96.CrossRefGoogle Scholar
  41. 41.
    Masselli G, Derchi L, McHugo J, et al. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol. 2013;23:3485–500.CrossRefGoogle Scholar
  42. 42.
    Dewhurst C, Beddy P, Pedrosa I. MRI evaluation of acute appendicitis in pregnancy. J Magn Reson Imaging. 2013;37:566–75.CrossRefGoogle Scholar
  43. 43.
    Zachariah SK, Fenn MG. Acute intestinal obstruction complicating pregnancy: diagnosis and surgical management. BMJ Case Rep. 2014;2014:bcr2013203235.CrossRefGoogle Scholar
  44. 44.
    Daimon A, Terai Y, Nagayasu Y, et al. A case of intestinal obstruction in pregnancy diagnosed by MRI and treated by intravenous hyperalimentation. Case Rep Obstet Gynecol. 2016;2016:8704035.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Masselli G, Gualdi G. MR imaging of the small bowel. Radiology. 2012;264:333–48.CrossRefGoogle Scholar
  46. 46.
    Ellington SR, Flowers L, Legardy-Williams JK, Jamieson DJ, Kourtis AP. Recent trends in hepatic diseases during pregnancy in the United States, 2002–2010. Am J Obstet Gynecol. 2015;212(4):524.e1–7.CrossRefGoogle Scholar
  47. 47.
    Ralls PW, Halls J, lapin SA, et al. Prospective evaluation of the sonographic Murphy sign in suspected acute cholecystitis. JCU. 1982;10:113–5.PubMedGoogle Scholar
  48. 48.
    Hara T, Kanasaki H, Oride A, Ishihara T, Kyo SA. Case of idiopathic acute pancreatitis in the first trimester of pregnancy. Case Rep Obstet Gynecol. 2015;2015:469527.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Papadakis EP, Sarigianni M, Mikhailidis DP, Mamopoulos A, Karagiannis V. Acute pancreatitis in pregnancy: an overview. Eur J Obstet Gynecol Reprod Biol. 2011;159:261–6.CrossRefGoogle Scholar
  50. 50.
    Bennett M. Do not forget about HELLP! BMJ Case Rep. 2011;28:2011.Google Scholar
  51. 51.
    Pedrosa I, Morrin M, Oleaga L, Baptista J, Rofsky NMI. true FISP imaging reliable in the evaluation of venous thrombosis? Am J Roentgenol. 2005;185:1632–40.CrossRefGoogle Scholar
  52. 52.
    Pedrosa I, Zeikus EA, Levine D, Rofsky NM. Is true MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics. 2007;27:721–43.CrossRefGoogle Scholar
  53. 53.
    Munir SI, Lo T, Seaton J. Spontaneous rupture of utero-ovarian vessels in pregnancy. BMJ Case Rep. 2012;30:2012.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gabriele Masselli
    • 1
    Email author
  • Martina Derme
    • 2
  • Gianfranco Gualdi
    • 1
  1. 1.Radiology DepartmentUmberto I Hospital, Sapienza UniversityRomeItaly
  2. 2.Gynecology and Obstetrics DepartmentUmberto I Hospital, Sapienza UniversityRomeItaly

Personalised recommendations