Upper abdominal pain in pregnancy Immediate admission is inappropriate

EDITOR, — Christopher Barry and colleagues recommend that women who present with epigastric pain and tenderness in pregnancy should be admitted to hospital immediately for exclusion of pre-eclampsia even if they do not have hypertension or proteinuria.1 In two of the cases that they report the general practitioner initially diagnosed the presenting symptom of epigastric pain as indigestion.

In my general practice 169 women delivered in 1993. Sixty eight of them had indigestion sufficient to require antacids, and three also required advice for “rib splay.” The number with rib splay is an underestimate as the midwives consider this condition to be so common that they often fail to record it. I question the appropriateness of a recommendation that …