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Pelvic Pain During Early Pregnancy

By

Emily E. Bunce

, MD, Wake Forest Baptist Health;


Robert P. Heine

, MD, Wake Forest School of Medicine

Last full review/revision Jun 2021| Content last modified Jun 2021
Click here for the Professional Version
Topic Resources

Early in pregnancy, many women have pelvic pain. Pelvic pain refers to pain in the lowest part of the torso, in the area below the abdomen and between the hipbones (pelvis). The pain may be sharp or crampy (like menstrual cramps) and may come and go. It may be sudden and excruciating, dull and constant, or some combination. Usually, temporary pelvic pain is not a cause for concern. It can occur normally as the bones and ligaments shift and stretch to accommodate the fetus.

Pelvic pain differs from abdominal pain, which occurs higher in the torso, in the area of the stomach and intestine. However, sometimes women have trouble discerning whether pain is mainly in the abdomen or pelvis. Causes of abdominal pain during pregnancy are usually not related to the pregnancy.

Causes

During early pregnancy, pelvic pain may result from disorders that are related to

  • The pregnancy (obstetric disorders)

  • The female reproductive system (gynecologic disorders) but not the pregnancy

  • Other organs, particularly the digestive tract and urinary tract

Sometimes no particular disorder is identified.

The most common obstetric causes of pelvic pain during early pregnancy are

In a miscarriage that has occurred, all of the contents of the uterus (fetus and placenta) may be expelled (complete abortion) or not (incomplete abortion).

The most common serious obstetric cause of pelvic pain is

When an ectopic pregnancy ruptures, blood pressure may drop very low, the heart may race, and blood may not clot normally. Immediate surgery may be required.

Pelvic pain may also occur when an ovary twists around the ligaments and the tissues that support it, cutting off the ovary's blood supply. This disorder, called adnexal torsion Adnexal Torsion Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, cutting off the blood supply of these organs. Twisting causes sudden, severe pain and often vomiting. Doctors use an... read more , is not related to the pregnancy but is more common during pregnancy. During pregnancy, the ovaries enlarge, making an ovary more likely to twist.

Digestive and urinary tract disorders, which are common causes of pelvic pain in general, are also common causes during pregnancy. These disorders include the following:

Pelvic pain during late pregnancy may result from labor or from a disorder unrelated to the pregnancy.

Risk factors

Various characteristics (risk factors) increase the risk of some obstetric disorders that cause pelvic pain.

For miscarriage, risk factors include the following:

For ectopic pregnancy, risk factors include the following:

Evaluation

If a pregnant woman has sudden, very severe pain in the lower abdomen or pelvis, doctors must quickly try to determine whether prompt surgery is required—as is the case when the cause is a ruptured ectopic pregnancy or appendicitis.

Warning signs

In pregnant women with pelvic pain, the following symptoms are cause for concern:

When to see a doctor

Women with warning signs should see a doctor immediately.

Women without warning signs should try to see a doctor within a day or so if they have pain or burning during urination or pain that interferes with daily activities. Women with only mild discomfort and no other symptoms should call the doctor. The doctor can help them decide whether and how quickly they need to be seen.

What the doctor does

To determine whether emergency surgery is needed, doctors first check blood pressure and temperature and ask about key symptoms, such as vaginal bleeding. Doctors then ask about other symptoms and the medical history. They also do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes and Features of Pelvic Pain During Early Pregnancy Some Causes and Features of Pelvic Pain During Early Pregnancy Early in pregnancy, many women have pelvic pain. Pelvic pain refers to pain in the lowest part of the torso, in the area below the abdomen and between the hipbones (pelvis). The pain may be... read more ).

Doctors ask about the pain:

  • Whether it begins suddenly or gradually

  • Whether it occurs in a specific spot or is more widespread

  • Whether moving or changing positions worsens the pain

  • Whether it is crampy and whether it is constant or comes and goes

Doctors also ask about the following:

  • Other symptoms, such as vaginal bleeding, a vaginal discharge, a need to urinate often or urgently, vomiting, diarrhea, and constipation

  • Previous pregnancy-related events (obstetric history), including past pregnancies, miscarriages, and intentional terminations of pregnancy (induced abortions) for medical or other reasons

  • Risk factors for miscarriage and ectopic pregnancy

The physical examination focuses on the pelvic examination Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more (examination of the external and internal reproductive organs and sometimes the rectum). Doctors gently press on the abdomen to see whether pressing causes any pain.

Table
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Testing

A pregnancy test using a urine sample is almost always done. If the pregnancy test is positive, ultrasonography of the pelvis is done to confirm that the pregnancy is normally located―in the uterus―rather than somewhere else (an ectopic pregnancy). For this test, a handheld ultrasound device is placed on the abdomen, inside the vagina, or both.

Blood tests are usually done. If a woman has vaginal bleeding, testing usually includes a complete blood cell count and blood type plus Rh status Rh Incompatibility Rh incompatibility occurs when a pregnant woman has Rh-negative blood and the fetus has Rh-positive blood. Rh incompatibility can result in destruction of the fetus’s red blood cells, sometimes... read more (positive or negative), in case the woman needs a transfusion. Knowing Rh status also helps doctors prevent problems in subsequent pregnancies.

If doctors suspect an ectopic pregnancy, testing also includes a blood test to measure a hormone produced by the placenta early during pregnancy (human chorionic gonadotropin, or hCG). If symptoms (such as very low blood pressure or a racing heart) suggest that an ectopic pregnancy may have ruptured, blood tests are done to determine whether the woman's blood can clot normally.

Other tests are done depending on which disorders are suspected. Doppler ultrasonography, which shows the direction and speed of blood flow, helps doctors identify a twisted ovary, which can cut off the ovary’s blood supply. Other tests can include cultures of blood, urine, or a discharge from the vagina and urine tests (urinalysis) to check for infections.

If pain is persistently troublesome and the cause remains unknown, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to directly view the uterus, fallopian tubes, and ovaries to further evaluate the cause of the pain. Rarely, a larger incision (a procedure called laparotomy) is required.

Treatment

Specific disorders are treated, as in the following examples:

If pain relievers are needed, acetaminophen is the safest one for pregnant women, but if it is ineffective, an opioid may be necessary.

Pain due to normal changes during pregnancy

Women may be advised to

  • Change the activity causing pain

  • Avoid heavy lifting or pushing

  • Maintain good posture

  • Sleep with a pillow between their knees

  • Rest as much as possible with their back well-supported

  • Apply heat to painful areas

  • Do Kegel exercises (squeezing and releasing the muscles around the vagina, urethra, and rectum)

  • Use a maternity support belt

  • Possibly try acupuncture

Key Points

  • Pelvic pain during early pregnancy usually results from changes that occur normally during pregnancy.

  • Sometimes it results from disorders, which may be related to the pregnancy, to female reproductive organs but not the pregnancy, or to other organs.

  • Doctors’ first priority is to identify disorders that require emergency surgery, such as an ectopic pregnancy or appendicitis.

  • Ultrasonography is usually done.

  • General measures (such as resting and applying heat) can help relieve pain due to the normal changes during pregnancy.

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