This document outlines the evaluation and management of a 25-year-old pregnant woman at 30 weeks and 3 days gestation presenting with abdominal pain. It discusses differential diagnoses including placental abruption, UTI, and ovarian cyst. The objectives are listed as evaluating causes of third trimester abdominal pain, eliciting history for preterm labor, and outlining preterm labor management and predictors. The evaluation involves history, exam, ultrasound, and tests. The management of preterm labor includes bed rest, tocolytics, steroids, monitoring during labor, and possible NICU admission. Predictors of preterm labor are also mentioned.

1. 25 years primigravida with LMP on
28.02.2016 attended AN OPD with
complain of pain abdomen on 29.09.2016.
• What are the differential diagnosis of the
condition?
• How will you evaluate the women?
• Outline the management plan .

2. OBJECTIVES
• At the end of the session the students should be able
• To list different causes of pain abdomen during 3rd
trimester
• To elicit relevant history for preterm labour.
• To out line the management of preterm labour.
• To list the predictors of preterm labour.

3. Calculate the followings
• Expected date of confinement
• Period of gestation on the date of
visit. (29.09.2016)
LMP:-28.02.2016 EDC:- 07.11.2016
 30weeks and 3 days

4. Disease/Condition Differentiating Signs/Symptoms Differentiating Tests
Placental abruption This can occur with or without vaginal bleeding
(concealed abruption). Signs of fetal distress
(abnormal fetal heart rate pattern) or the presence
of blood in the vagina increase its likelihood. It
may also lead to preterm labor.
A nonstress test may reveal an abnormal fetal heart rate
pattern.
Kleihauer test: this blood test demonstrates fetal cells in
the maternal circulation.
Urinary tract infection
(UTI)
A previous history of UTI, abdominal pain, dysuria,
or increased frequency of urination. This may lead
to preterm labor.
Urinalysis for nitrites, leukocytes, and protein.
Urine culture: positive growth of specific microorganism.
Ovarian cyst Can mimic preterm labor. May have nonspecific
signs of abdominal pain or backache. May present
with tachycardia, low BP, nausea and vomiting, or
localized abdominal pain.
US pelvis: may reveal an ovarian mass or free fluid in the
abdomen.
Ovarian torsion Can mimic preterm labor. May present with
nonspecific abdominal or back pain and
associated symptoms of nausea and vomiting.
Ultrasound (US) pelvis: may reveal an ovarian mass or
free fluid in the abdomen.
CT abdomen: generally avoided in pregnancy but will
demonstrate ovarian torsion.
Appendicitis Abdominal pain may be higher in the abdomen
and more diffuse. May have accompanying
symptoms of nausea, vomiting, and loss of
appetite.
US abdomen: may reveal an appendix mass.
WBC and CRP may be elevated.
Differential Diagnosis

5. History : previous preterm/ medical disorder / present pregnancy
complications
Associated symptoms : • Discharge per vagina
• Bleeding per vagina
• Dysuria / Constipation / Nausea/
• Vomiting/ Hematemesis/ Fever
Characteristics of pain : Onset, Site, Radiation, aggravating & relieving
factors
• Insidious, Mild , Non-descriptive , Non-
persisting
• Acute , Severe , Radiating , Persisting
long ,

6. Examinations:
General :
Abdominal :
• Uterus
• Alder sign
Tachycardia, Temperature ,Pallor
• Contraction
• Shifting of point of
tenderness with the
shifting of position of
patient.

7. Investigations:
Ultrasound :
Special :
Stool:
Urine : • Pus Cell, Bacteria, RBC
• Crystal
• Cyst & Ova
• Retro-placental clot
• MRI, Endoscopy

8. Pain
abdomen
in
pregnancy
Pregnancy
related
Medical
Surgical
Gynecological
Undiagnosed

9. Management of Pre term Labour
• Arrest of Pre term Labour • Management in Labour
• Bed rest
• Hydration
• Tocolytics
• Glucocrticoids
• 1st Stage • 2nd Stage
• Confine to bed
• O2
• Foetal
monitoring
• NICU
• Slow & Gentle
• Episiotomy
• Forceps
• Early cord
clamping
• NICU
admission

10. Clinical
History
MFG
Infection
Biophysical
Uterine
contraction
Bishop score ≥
4 cm
Cervical length
≤ 2.5 cm
Biochemical
Foetal
fibronectin
IL-6 & 8,
TNF-α
Predictors