Table: Some Causes and Features of Pelvic Pain During Early Pregnancy

Some Causes and Features of Pelvic Pain During Early Pregnancy

Cause	Common Features^*	Tests^†
Pregnancy-related (obstetric) disorders
An ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus)	Abdominal or pelvic pain that Is often sudden and constant (not crampy) Begins in a specific spot May or may not be accompanied by vaginal bleeding If the ectopic pregnancy has ruptured, possibly fainting, light-headedness, or a racing heart	A blood test to measure a hormone produced by the placenta (human chorionic gonadotropin, or hCG) Ultrasonography of the pelvis Sometimes laparoscopy (insertion of a viewing tube through an incision in the abdomen) or laparotomy (surgery involving an incision into the abdomen)
A miscarriage that Has occurred or is occurring (spontaneous abortion) May occur (threatened abortion)	Crampy pain in the pelvis and often throughout the abdomen Often vaginal bleeding, sometimes with passage of tissue from the fetus	Tests as for ectopic pregnancy
Septic abortion (infection of the contents of the uterus before, during, or after a miscarriage)	Usually in women who have had an abortion (often done by untrained practitioners or by the women themselves) Fever and chills, constant abdominal or pelvic pain, and a vaginal discharge that contains pus	Ultrasonography of the pelvis Cultures of a sample taken from the cervix (the lower part of the uterus)
Normal changes of pregnancy, including stretching and growth of the uterus during early pregnancy	A crampy or burning sensation in the lower abdomen, pelvis, and/or lower back	Ultrasonography of the pelvis
Gynecologic disorders unrelated to the pregnancy
Degeneration of a fibroid in the uterus	Pelvic pain that Begins suddenly Is often accompanied by nausea, vomiting, and fever Sometimes vaginal bleeding	Ultrasonography of the pelvis
Adnexal torsion (twisting) of an ovary	Pelvic pain that Begins suddenly May be cramping and is often mild if the ovary untwists on its own Often nausea or vomiting	Doppler ultrasonography (to evaluate blood flow to and from the ovary) Sometimes laparoscopy or laparotomy
Rupture of a corpus luteum cyst (which develops in the structure that releases the egg after the egg is released)	Abdominal or pelvic pain that Occurs in a specific spot Sometimes resembles pain due to a twisted ovary Usually begins suddenly Vaginal bleeding	Ultrasonography of the pelvis Sometimes laparoscopy or laparotomy
Pelvic inflammatory disease (which is uncommon during pregnancy)	Pelvic pain that Is continuous Usually develops gradually Usually occurs on both sides A vaginal discharge that contains pus Sometimes fever or chills More common among women who have sexual intercourse with new partners and do not use condoms or diaphragms	Cultures of a sample taken from the cervix Sometimes ultrasonography of the pelvis
Other disorders
Appendicitis	Usually continuous pain and tenderness in the lower right part of the abdomen Possibly pain in a different location (for example, higher in the abdomen) or a different kind of pain (milder and crampy) from that in people who are not pregnant	Cultures of a sample taken from the cervix Ultrasonography of the pelvis and abdomen Possibly CT if ultrasonography is inconclusive
Urinary tract infections	Discomfort felt in the area over the pubic bone Often burning during urination, an urge to urinate often (frequency), and a need to urinate immediately (urgency) Sometimes blood in urine	Urine tests (urinalysis) and culture
Inflammatory bowel disease including Crohn disease Ulcerative colitis	Pain that May be crampy or constant Can occur in various locations Often diarrhea that sometimes contains mucus or blood Usually in women known to have the disease	Sometimes endoscopy of the upper digestive tract, lower digestive tract (sigmoidoscopy or colonoscopy), or both
A blockage in the intestine (intestinal obstruction)	Cramping pain that comes and goes Vomiting No bowel movements or gas (flatulence) A swollen abdomen Usually in women who have had abdominal surgery	Cultures of a sample taken from the cervix Ultrasonography of the pelvis and abdomen Possibly CT if ultrasonography is inconclusive
Gastroenteritis	Usually vomiting and diarrhea	A doctor's examination
^*Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.
^†A urine pregnancy test is typically done if women have had only a home pregnancy test. Because an ectopic pregnancy can be very dangerous, tests are done to look for ectopic pregnancy in most pregnant women with pelvic pain, unless symptoms clearly point to another disorder (such as gastroenteritis).
CT= computed tomography.

Merck Manual

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Some Causes and Features of Pelvic Pain During Early Pregnancy