Pelvic pain in the first trimester of pregnancy:
Many women undergo pelvic pain during the first months of pregnancy. It is a pain found in the lower part of the torso, in the area that is below the abdomen and between the bones of the hip (pelvis). The pain can be sharp or crampy, like menstrual cramps, and it can come and go. It can be sudden and unbearable, dull and steady, or a combination of these. Temporary pelvic pain is usually not a cause for concern. It occurs under normal conditions because the bones and ligaments move and stretch to accommodate the fetus.
If it is due to a disorder, it may be accompanied by other symptoms, such as vaginal bleeding. In some disorders, the bleeding can be severe and sometimes cause a dangerous drop in blood pressure ( shock ).
Pelvic pain differs from abdominal pain, which occurs higher up in the torso, in the stomach and intestine area. However, it is sometimes difficult to discern whether the pain is in the abdomen or the pelvis. Abdominal pain during pregnancy is not usually due to pregnancy.
Causes of pelvic pain in the first trimester of pregnancy
During the first trimester of pregnancy, pelvic pain can be caused by disorders related to
- Pregnancy (obstetric disorders).
- The female reproductive system (gynecological disorders), but not pregnancy.
- Other organs, especially the urinary tract and digestive tract.
Sometimes no particular disorder is identified.
The most popular obstetric problems of pelvic pain during early pregnancy are:
- Normal pregnancy changes
- A miscarriage (miscarriage) in progress or that has already taken place
- A miscarriage that may occur (threatened abortion)
In a miscarriage that has already taken place, the entire contents of the uterus (the fetus and placenta) may have been expelled, which is called a complete miscarriage, or the expulsion may not have been complete, which is known as an abortion. incomplete spontaneous.
We recommend you to read another article on kidsrush.com which is about Why Am I Not Getting Pregnant?
The most common serious obstetric cause of pelvic pain is:
- The detachment of an ectopic pregnancy, a pregnancy that has not implanted in the usual place in the uterus, but, for example, in a fallopian tube
When an ectopic pregnancy is dislodged, blood pressure can drop too low, the heart races, and the blood doesn’t clot properly. In this case, it is necessary to perform surgery immediately.
Pelvic pain can also occur when an ovary twists around the ligaments and supporting tissues, interrupting the supply of blood to the ovary. This disorder, called adnexal torsion, is not due to pregnancy but is more common during this period. In pregnancy, the ovaries enlarge, making them more likely to twist.
Disorders of the digestive tract and urinary tract, which are common causes of pelvic pain in general, are also common during pregnancy. These disorders include:
- Gastroenteritis (infection of the digestive tract) caused by a virus
- Irritable bowel syndrome or irritable bowel
- Inflammatory bowel disease
- Urinary tract infections ( UTI )
- Kidney stones
Pelvic pain during late pregnancy may be due to labor or a condition unrelated to pregnancy.
Several characteristics (risk factors) increase the risk of some obstetric disorders that cause pelvic pain.
Risk factors for miscarriage are:
- Age above 35 years
- Having suffered one or more miscarriages in previous pregnancies
- Cigarette smoking
- Using drugs such as cocaine, alcohol, or a large amount of caffeine
- Abnormalities in the uterus, such as fibroids or scars, caused by surgery, D&C, radiation therapy, or infections
Risk factors for ectopic pregnancy are:
- Having had an ectopic pregnancy before (the most important risk factor)
- Having had previous abdominal surgery, especially sterilization surgery (tubal ligation)
- Having had a previous infection with a sexually transmitted disease or pelvic inflammatory disease
- Cigarette smoking
- Using an intrauterine device (IUD)
- Be over 35 years of age
- Having a history of infertility, taking fertility drugs, or using assisted reproductive techniques
- Have multiple sexual partners
If a pregnant woman experiences sudden, severe pain in the lower abdomen or pelvis, it should be quickly assessed whether surgery is needed immediately, such as whether the cause is an ectopic pregnancy or appendicitis.
Warning signs of pelvic pain during the first trimester of pregnancy
If a pregnant woman experiences pelvic pain, the following symptoms are cause for concern:
- Fainting, dizziness, or palpitations – symptoms that indicate very low blood pressure
- Fever and chills, especially if accompanied by vaginal discharge with pus
- Vaginal bleeding (gynecology)
- Severe pain that worsens with movement
When to go to the doctor
A woman with warning signs should go to the consultation immediately.
If there are no warning signs, you should try to see a doctor after a day if you feel pain or burning when urinating or if the pain interferes with daily activities. When the discomfort is mild and there are no other symptoms, just call the doctor. This can help you decide when and if you need to come in for your visit.
To determine if urgent surgery is necessary, blood pressure and temperature should first be measured and asked about the main symptoms, such as vaginal bleeding. Next, you ask about other symptoms and medical history. A physical examination is also done. What they find during the history and physical examination often suggests a cause and tests needed.
The doctor asks about the pain:
- If it appeared suddenly or gradually
- Does it occur in a specific place or is it more widespread?
- Does it get worse when moving or changing posture?
- Is it colicky and constant or intermittent?
Doctors also ask about the following:
- Other symptoms, such as vaginal bleeding, vaginal discharge, the need to urinate frequently or urgently, vomiting, diarrhea, and constipation
- Past Events related to pregnancy (obstetric history), including past pregnancies, miscarriages, and abortions induced for medical or other reasons
- Risk factors for miscarriage and ectopic pregnancy
A physical examination that includes a pelvic examination should be performed. The doctor gently presses on the abdomen to check if the pressure causes any pain.
Supplementary tests of the pelvic pain in the first trimester of pregnancy
The doctor uses a hand-held Doppler ultrasound device, which he places on the woman’s abdomen, to detect the fetal heartbeat.
A pregnancy test is almost always done with a urine sample. If the pregnancy test result is positive, an ultrasound of the pelvis is done to confirm that the pregnancy is in its normal location, in the uterus, and not elsewhere (ectopic pregnancy). In this test, a handheld ultrasound device is placed on the abdomen, inside the vagina, or both.
Blood tests are also usually done. If there has been vaginal bleeding, the test usually includes a complete blood count and blood type plus Rh factor (positive or negative), in case a transfusion is necessary. Knowing your Rh also helps prevent complications in later pregnancies.
If the pregnancy is suspected to be ectopic, the tests also include a blood test to measure a hormone produced by the placenta during the first months of pregnancy (human chorionic gonadotropin, hCG). If symptoms (such as very low blood pressure or palpitations) indicate a detachment of an ectopic pregnancy, blood tests are done to determine if the woman’s blood is clotting normally.
Depending on the suspected disorder, other tests are done. Doppler ultrasound, which shows the direction and speed of blood flow, can detect a twisted ovary, which can cut off the blood supply to the ovary. Other tests may include cultures of blood, urine, or vaginal discharge, as well as urinalysis for infection.
If the pain persists in a problematic way and the cause is still unknown, a small incision is made just below the belly button and an observation tube (laparoscope) is inserted to directly view the uterus to identify the cause of the pain. In rare cases, the incision needs to be larger (a procedure called a laparotomy).
Treatment of pelvic pain
Specific disorders must be treated. If pain relievers are needed, paracetamol (acetaminophen) is the safest in pregnancy, but if it is not effective, an opioid may be necessary.
Pain due to normal changes during pregnancy
Women are recommended:
- Limit movements, but move often.
- Avoid pushing or lifting heavy objects.
- Maintain good posture.
- Sleep with a pillow between your knees.
- Rest as much as possible with your back supported.
- Apply heat to painful areas.
- Do Kegel exercises (tighten and release the muscles around the vagina, urethra, and rectum).
- Wear a prenatal girdle.
- Possibly try acupuncture.
- Pelvic pain during the first trimester of pregnancy is usually due to the normal changes in this period.
- Sometimes it is the result of disorders that may be related to pregnancy and the female reproductive organs, but not to pregnancy or other organs.
- The doctor’s priority is to detect conditions that require emergency surgery, such as an ectopic pregnancy or appendicitis.
- An ultrasound is usually done.
- General measures (such as resting and applying heat) can help relieve pain caused by normal pregnancy changes.