Abdomina Pain in Preg < 20wks
-VS unremarkeable
-Reportedly less than 20wks gestation
-Overall well appearing. Abdomen is nontender. Does not appear dehydrated. Based on exam, it seems most likely this pain is related to pregnancy. I see no evidence of serious surgical process such as appendicitis, cholecystitis, diverticulitis, bowel obstruction, AAA, dissection, vascular occlusion or any reason to get CT imaging at this time. Discussed the risks and benefits of CT with the mother and she agreed with conservative testing with US and labs for now.
-No reported vaginal bleeding, discharge. No indication for RhoGam.
-Pending pelvic US, labs, UA
Re-exam, IUP, DC
US shows living IUP. No evidence of torsion, toa. Labs without major abnormality. UA neg. Vitals are stable. Abdomen still nontender without any evidence of surgical abdomen or peritonitis requiring higher level imaging. Discussed with the patient that this is most likely a symptom of a benign process such as round ligament pain, ruptured cyst, or even general pain of pregnancy. We also discussed that time is part of the diagnostic process and that if her symptoms worsen or do not improve she should seek immediate medical attention. She has agreed with the plan for prompt OB followup within the next 48 hours. Return precautions were extensively discussed. She understands to return for any worsening symptoms or failure to improve.
Re-exam, No IUP, DC
US showed no apparent IUP. No evidence of torsion, toa. Labs without major abnormality. bHCG was [above/below] discretionary threshold. This is considered pregnancy of unknown location at this point. This was discussed at length with the patient including the risk of ectopic and what that means. On repeat exam, abdomen is nontender without evidence of surgical abdomen or peritonitis. Vitals are stable. I still see no reason for higher level imaging. I discussed the need for repeat labs(bHCG) and US within the next 48-72 hours AND the need for prompt OB followup in this time. She understands and agrees with the plan for discharge and followup and she is comfortable with this plan. Return precautions were extensively discussed and the understands to return for any worsening symptoms or failure to improve.
- Last updated January 27, 2023