Surgery during pregnancy

You are a doctor at the emergency department. In the evening, 29-year-old female patient is entering, primipara, in the 22nd week of pregnancy with physiological pregnancy. She complains about sharp pain localized in umbilical region with progression into right lumbar region. She feels really sick and says she vomited twice today (gastric contents). This symptoms have lasted for 24 hours. It has occurred suddenly. She feels pain relief while half seated with bended knees. What will be your next step?

Help

Nausea and pain are common during a pregnancy. Neither laboratory nor clinical picture is significant. I release the patient to homecare. I recommend her to come back to the emergency department in case her condition worsens.

I suggest US examination. I'll add a gynaecological and surgical consultation to consider next steps.

Because I suspect acute abdomen I'll add native abdominal X-ray imaging as the best diagnostic method in this case. I'll add a gynecological and surgical consultation.

years

woman

19 /min

110 /min

SpO2

98 %

106/68 (81) mmHg

temperature

37 °C

EKG

rythm: sinus
action: regular
frequency: 110 bpm

Examination

PMH: tonsillectomy as a child without complications. PA, AA, EA: 0
Physical examination: subfebrile, breathing clean, eupnoe, palpable resistance in the right lumbar and iliac region, Rovsing´s sign negative, Pleniér´s and Blumberg´s sign positive, uterus enlarged over symphysis, without urination difficulty, urine clear, stool without pathological admixtures.

Glycaemia

Take a sample

Arterial blood gas

Take a sample

Complete blood count

Take a sample

Biochemical analysis

Take a sample

Inflammatory markers

Take a sample

Renal markers

Take a sample