Gynecologic Etiologies of Abdominal Pain in Pregnancy

This chapter discusses diagnosis and management of gynecologic causes of abdominal pain in pregnancy. Causes can range from benign to malignant to ones requiring immediate surgical attention. Most masses diagnosed in pregnancy are found incidentally on routine obstetrical ultrasound and remain asymptomatic throughout gestation. However, when they become symptomatic, high clinical suspicion may be life-saving. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol. 2006;101(2):315–21. Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med. 2001;38(2):156–9. White M, Stella J. Ovarian torsion: 10-year perspective. Emerg Med Australas. 2005;17(3):231–7. Johnson TR, Woodruff JD. Surgical emergencies of the uterine adnexae during pregnancy. Int J Gynaecol Obstet. 1986;24(5):331–5. Yen C-F, Lin S-L, Murk W, Wang C-J, Lee C-L, Soong Y-K, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril. 2009;91(5):1895–902. Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999;93(4):585–9. Sarandakou A, Protonotariou E, Rizos D. Tumor markers in biological fluids associated with pregnancy. Crit Rev Clin Lab Sci. 2007;44(2):151–78. Gucer F, Kiran G, Canaz E, Kilinc M, Ekerbicer HC, Avci F, et al. Serum human epididymis protein 4 can be a useful tumor marker in the differential diagnosis of adnexal masses during pregnancy: a pilot study. Eur J Gynaecol Oncol. 2015;36(4):406–9. Moore RG, Miller MC, Eklund EE, Lu KH, Bast RC, Lambert-Messerlian G. Serum levels of the ovarian cancer biomarker HE4 are decreased in pregnancy and increase with age. Am J Obstet Gynecol. 2012;206(4):349.e1–7. Wilkinson C, Sanderson A. Adnexal torsion – a multimodality imaging review. Clin Radiol. 2012;67(5):476–83. Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med. 2011;30(9):1205–10. Lee GSR, Hur SY, Shin JC, Kim SP, Kim SJ. Elective vs. conservative management of ovarian tumors in pregnancy. Int J Gynaecol Obstet. 2004;85(3):250–4. Leiserowitz GS. Managing ovarian masses during pregnancy. Obstet Gynecol Surv. 2006;61(7):463–70. Strobelt N, Ghidini A, Cavallone M, Pensabene I, Ceruti P, Vergani P. Natural history of uterine leiomyomas in pregnancy. J Ultrasound Med. 1994;13(5):399–401. Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol. 2009;113(3):630–5. Stout MJ, Odibo AO, Graseck AS, Macones GA, Crane JP, Cahill AG. Leiomyomas at routine second-trimester ultrasound examination and adverse obstetric outcomes. Obstet Gynecol. 2010;116(5):1056–63. Aharoni A, Reiter A, Golan D, Paltiely Y, Sharf M. Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study. Br J Obstet Gynaecol. 1988;95(5):510–3. Rosati P, Exacoustòs C, Mancuso S. Longitudinal evaluation of uterine myoma growth during pregnancy. A sonographic study. J Ultrasound Med. 1992;11(10):511–5. De Carolis S, Fatigante G, Ferrazzani S, Trivellini C, De Santis L, Mancuso S, et al. Uterine myomectomy in pregnant women. Fetal Diagn Ther. 2001;16(2):116–9. Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol. 1989;160(5 Pt 1):1212–6. Hurley V. Imaging techniques for fibroid detection. Baillière’s. Clin Obstet Gynaecol. 1998;12(2):213–24. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. Committee Opinion No. 656: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2016;127(2):e75–80. Dildy GA, Moise KJ, Smith LG, Kirshon B, Carpenter RJ. Indomethacin for the treatment of symptomatic leiomyoma uteri during pregnancy. Am J Perinatol. 1992;9(3):185–9. Straub HL, Chohan L, Kilpatrick CC. Cervical and prolapsed submucosal leiomyomas complicating pregnancy. Obstet Gynecol Surv. 2010;65(9):583–90. Burton CA, Grimes DA, March CM. Surgical management of leiomyomata during pregnancy. Obstet Gynecol. 1989;74(5):707–9. Currie A, Bradley E, McEwen M, Al-Shabibi N, Willson PD. Laparoscopic approach to fibroid torsion presenting as an acute abdomen in pregnancy. JSLS. 2013;17(4):665–7. Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198(4):357–66. Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol. 2006;107(2 Pt 1):376–82. Ouyang DW, Economy KE, Norwitz ER. Obstetric complications of fibroids. Obstet Gynecol Clin N Am. 2006;33(1):153–69. Vergani P, Locatelli A, Ghidini A, Andreani M, Sala F, Pezzullo JC. Large uterine leiomyomata and risk of cesarean delivery. Obstet Gynecol. 2007;109(2 Pt 1):410–4. Moen MH, Muus KM. Endometriosis in pregnant and non-pregnant women at tubal sterilization. Hum Reprod. 1991;6(5):699–702. Pisanu A, Deplano D, Angioni S, Ambu R, Uccheddu A. Rectal perforation from endometriosis in pregnancy: case report and literature review. World J Gastroenterol. 2010;16(5):648. Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril. 2009;92(4):1243. Brosens IA, Lier MC, Mijatovic V, Habiba M, Benagiano G. Severe spontaneous hemoperitoneum in pregnancy may be linked to in vitro fertilization in patients with endometriosis: a systematic review. Fertil Steril. 2016;106(3):692–703. Epub 2016 Jun 20. Lier M, Malik RF, van Waesberghe J, Maas JW, et al. Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series. BJOG. 2017;124(2):306–12. Chiodo I, Somigliana E, Dousset B, Chapron C. Urohemoperitoneum during pregnancy with consequent fetal death in a patient with deep endometriosis. J Minim Invasive Gynecol. 2008;15(2):202–4. Leone Roberti Maggiore U, Remorgida V, Sala P, Vellone VG, Biscaldi E, Ferrero S. Spontaneous Uroperitoneum and preterm delivery in a patient with bladder endometriosis. J Minim Invasive Gynecol. 2015;22(6):923–4. Epub 2015 Jan 22. Faucheron JL, Pasquier D, Voirin D. Endometriosis of the vermiform appendix as an exceptional cause of acute perforated appendicitis during pregnancy. Color Dis. 2008;10(5):518. Murphy SJ, Kaur A, Wullschleger ME. Endometrial decidualization: a rare cause of acute appendicitis during pregnancy. J Surg Case Rep. 2016;2016(4):rjw053. Epub 2016 Apr 22. Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update. 2016;22(1):70–103. Epub 2015 Oct 7. Glavind MT, Forman A, Arendt LH, Nielsen K, Henriksen TB. Endometriosis and pregnancy complications: a Danish cohort study. Fertil Steril. 2017;107(1):160–6. Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Bhattacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2017;124(3):444. Hadfield RM, Lain SJ, Raynes-Greenow CH, Morris JM, Roberts CL. Is there an association between endometriosis and the risk of pre-eclampsia? A population based study. Hum Reprod. 2009;24(9):2348. Brosens IA, De Sutter P, Hamerlynck T, Imeraj L, Yao Z, Cloke B, Brosens JJ, Dhont M. Endometriosis is associated with a decreased risk of pre-eclampsia. Hum Reprod. 2007;22(6):1725–9. Epub 2007 Apr 23. Van Calsteren K, Vergote I, Amant F. Cervical neoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol. 2005;19(4):611–30. Amant F, Halaska MJ, Fumagalli M, Dahl Steffensen K, Lok C, Van Calsteren K, et al. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer. 2014;24(3):394–403. Robinson WR, Webb S, Tirpack J, Degefu S, O’Quinn AG. Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision. Gynecol Oncol. 1997;64(1):153–5. Zagouri F, Sergentanis TN, Chrysikos D, Bartsch R. Platinum derivatives during pregnancy in cervical cancer. Obstet Gynecol. 2013;121(2, PART 1):337–43. Tewari K, Cappuccini F, Gambino A, Kohler MF, Pecorelli S, DiSaia PJ. Neoadjuvant chemotherapy in the treatment of locally advanced cervical carcinoma in pregnancy: a report of two cases and review of issues specific to the management of cervical carcinoma in pregnancy including planned delay of therapy. Cancer. 1998;82(8):1529–34. Han C, Wang C, Liu X-J, Geng N, Wang Y-M, Fan A-P, et al. In vitro fertilization complicated by rupture of tubo-ovarian abscess during pregnancy. Taiwan J Obstet Gynecol. 2015;54(5):612–6. Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372(21):2039–48. Acquavella AP, Rubin A, D’Angelo LJ. The coincident diagnosis of pelvic inflammatory disease and pregnancy: are they compatible? J Pediatr Adolesc Gynecol. 1996;9(3):129–32. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137. Bevan CD, Ridgway GL, Rothermel CD. Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. J Int Med Res. 2003;31(1):45–54. Jacobson GF, Autry AM, Kirby RS, Liverman EM, Motley RU. A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of chlamydia trachomatis in pregnancy. Am J Obstet Gynecol. 2001;184(7):1352–4; discussion 1354–6. Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol. 2001;9(4):197–202. Amin BA, Edge SB, Greene FL. AJCC cancer staging manual. 8th ed. New York: Springer; 2016. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2018 Springer International Publishing AG About this chapter Cite this chapter Alrahmani, L., Magtibay, P.M., Magrina, J.F., Magtibay, P.M. (2018). Gynecologic Etiologies of Abdominal Pain in Pregnancy. In: Greenspan, P. (eds) The Diagnosis and Management of the Acute Abdomen in Pregnancy . Springer, Cham. https://doi.org/10.1007/978-3-319-62283-5_7 Download citation DOI: https://doi.org/10.1007/978-3-319-62283-5_7 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-62282-8 Online ISBN: 978-3-319-62283-5 eBook Packages: MedicineMedicine (R0)