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Pain due to ectopic pregnancy
Ectopic pregnancies, in the main, will be found in one of the fallopian tubes. They are also, to a much lesser degree, found elsewhere in the abdomen or pelvic cavity. The fallopian tube is a very small organ compared to the womb and its capacity to distend is comparatively limited.
As the pregnancy increases in size, the tube will distend, causing pain. Bleeding into the pelvic cavity will also occur, irritating the inner surface and increasing the pain felt inside the pelvis.
The pain is normally but not necessarily localized on one side in the lower part of the abdomen. The area will also be tender to touch. If the pain at this stage has not aroused the mother's concern as to there being something amiss, the tube will go on to rupture, which usually causes quite severe acute pain, even shock.
Most ectopic pregnancies reveal themselves well before 10 weeks of gestation. Ectopic pregnancy is therefore a cause of pain in early pregnancy.
Ectopic pregnancy without pain
This is possible but rare. Occasionally a patient may only have symptoms of vaginal spotting in early pregnancy, without any pain. The first inkling as to the probable diagnosis is when an ultrasound scan reveals an empty uterus in the presence of pregnancy symptoms and a positive pregnancy test.
It is important to remember that ectopic pregnancy is not always identifiable on the scan. In fact, the majority are diagnosed by exclusion.
Uterine rupture in pregnancy
There has to be an inherent weakness in the uterine wall for it to rupture spontaneously. Even in labor, when the uterus is subject to stresses and strains, this remains a rare occurrence.
Before labor, the main predisposing factor for this uterine rupture is a previous operation on the womb. This could have been a caesarean section or surgery to remove fibroids (myomectomy).
In labor, rupture may be caused by weakening of uterine muscles as a result of multiple
pregnancies (and deliveries), or over-
Uterine fibroids as a cause of pain in pregnancy
If a woman has fibroids, pregnancy usually makes them prone to undergo some kind of degeneration, which may cause pain. The pain is usually moderate, but occasionally may be severe enough to require admission into hospital and the use of strong painkillers. It usually clears up in due course. Surgery to remove degenerating fibroids during pregnancy is not a viable proposition.
Pain in pre-eclampsia
In severe pre-