Imaging of acute abdominal pain in the third trimester of pregnancyBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2511 (Published 21 June 2018) Cite this as: BMJ 2018;361:k2511
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The article published in the BMJ by J Shur, C Bottomley, K Walton, JH Patel: Imaging of abdominal pain in the third trimester of pregnancy, published 21 June 2018, is relevant and important in addressing a topic of interest and controversy in the daily medical practice of doctors who are dedicated to assisting pregnant women.
The possibilities of indicating and interpreting images that help in the positive diagnosis of the possible causes that cause abdominal pain in the third trimester of pregnancy constitute a large challenge today.
The published article reinforces "what every doctor should know" when facing the diagnostic challenge in a pregnant woman, orienting which are the first-line, non-invasive tests, either for the mother or for the fetus, besides considering the sequence to be used.
Pregnant women usually have episodes of abdominal pain or pelvic pain of small to moderate intensity throughout the pregnancy due to the numerous physiological and anatomical changes that happen.
Although most causes of abdominal pain in pregnancy are benign and expected, some of them may be a sign of a more serious problem, mainly in the third trimester of pregnancy.
The possibility of imaging for the diagnosis of abdominal pain in the last trimester of pregnancy is very useful, but it should be used according to an adequate interrogation and a detailed physical examination that clinically guides the patient's diagnostic possibilities.
We must bear in mind that there are abdominal pains in the course of pregnancy, both related and unrelated to pregnancy, so a detailed clinical history would be "a compass in a vast ocean."
Keep in mind that in the third trimester of pregnancy the uterus has grown enough to become an intra-abdominal organ (before, it is located only in the pelvis). Therefore, in addition to all the causes of "normal" abdominal pain in the first few trimesters, the pregnant woman will now live with the pain and discomfort caused by the compression of the abdominal organs by the uterus, in addition to the weight gain that the pelvis needs to support.
Like all individuals, pregnant women can also have abdominal diseases that are not specific to pregnancy, such as appendicitis, gastroenteritis, and kidney stones. The diagnosis of these problems is often more difficult in pregnant women due to the numerous changes that the abdominal region suffers. Even the location of the pain can be atypical.
We emphasize the importance of the use of imaging in the diagnosis of abdominal pain in the last trimester of pregnancy and we adhere to what was published in the BMJ article: "We suggest an early discussion of the case with a member of the multidisciplinary maternity team, a radiologist experienced and other relevant clinical teams”.
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Competing interests: No competing interests