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A common indication for imaging

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in the context of pregnancy is

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suspected abdominal pelvic pathology.

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There are numerous potential causes of

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abdominal pain in the pregnant patient,

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both obstetric and non-obstetric.

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Ultrasound remains the first-line imaging

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modality, whether you think the cause

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is obstetric or something more focal,

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such as right upper quadrant pain with

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suspicion for acute biliary pathology.

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CT is indicated in the pregnant patient

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in high-acuity situations, including

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trauma and suspected pulmonary embolism.

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An MRI can be useful for troubleshooting

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or further characterizing findings

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that are detected at initial imaging.

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This is a list of many, but not all, of

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the potential causes of abdominopelvic

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pain and pathology during pregnancy.

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These include gastrointestinal etiologies,

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very commonly acute appendicitis,

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cholecystitis, or pathology involving the

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gallbladder and biliary tree, HELLP syndrome,

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which is hemolysis with elevated liver

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enzymes and low platelets, which does occur

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in pregnant patients, pancreatitis, bowel

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obstruction, and inflammatory bowel disease.

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Genitourinary causes of abdominopelvic

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pain are also fairly common in pregnancy,

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including hydronephrosis of pregnancy,

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which is technically not pathologic, but is

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something you'll see because of mass effect

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of the gravid uterus on the distal ureter.

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Pregnant patients can also get

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obstructing stones or pyelonephritis.

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There are multiple gynecologic causes of

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abdominopelvic pain, including those

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related to the ovaries, such as ovarian

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torsion, ovarian cysts, adnexal masses,

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as well as uterine causes, such as

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fibroids, endometriosis, or mixed

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etiologies, such as tubo-ovarian abscess

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and pelvic inflammatory disease.

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Obstetrical causes of abdominal

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pelvic pain include ectopic pregnancy,

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placentation abnormalities, including

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placenta accreta spectrum, placental

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abruption, and preterm labor.

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Vascular etiologies include pelvic

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congestion syndrome, something that we

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see not infrequently, particularly later

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in pregnancy, and deep venous thrombosis,

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as pregnancy is a hypercoagulable state.

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Finally, it's important to remember that

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pregnant patients are just as susceptible to

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trauma as the general population, but are at

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a higher risk of intimate partner violence.