General / Acute Abdomen
Abdominal pain in pregnancy has a broad differential that includes benign pregnancy-related causes, surgical disease, hepatobiliary disorders, and obstetric emergencies.
Clinical points
- Pregnancy should not delay evaluation of suspected appendicitis, bowel obstruction, cholecystitis, perforation, or other surgical disease.
- Imaging should be chosen thoughtfully, but necessary diagnostic workup should not be withheld because of pregnancy alone.
- Acute abdomen in pregnancy requires parallel obstetric and nonobstetric assessment.
Dyspepsia, Nausea and Vomiting
Nausea and vomiting of pregnancy is common, while hyperemesis gravidarum is the more severe form associated with dehydration, metabolic disturbance, and weight loss.
Clinical points
- Distinguish typical nausea and vomiting of pregnancy from hyperemesis gravidarum and from other GI, metabolic, neurologic, or hepatobiliary causes of vomiting.
- Evaluate hydration, ketones, electrolyte status, and weight trajectory when symptoms are severe or persistent.
- Management usually escalates stepwise from dietary measures to antiemetics, IV fluids, thiamine support when indicated, and hospital care for severe disease.
Gallbladder Disease
Gallstones, biliary colic, cholecystitis, and biliary pancreatitis remain important nonobstetric causes of abdominal pain in pregnancy.
Clinical points
- Symptomatic gallbladder disease should be managed based on severity and recurrence, not dismissed as routine pregnancy discomfort.
- Ultrasound is usually the first-line imaging modality.
- Persistent or complicated disease may require surgical consultation during pregnancy.
Inflammatory Bowel Disease
The major modern principle in IBD and pregnancy is that remission before conception and during pregnancy improves outcomes, and many maintenance therapies should be continued rather than stopped reflexively.
Clinical points
- Active Crohn disease or ulcerative colitis is associated with worse pregnancy outcomes than well-controlled disease.
- Current consensus guidance supports continuing many effective maintenance therapies, including thiopurines and anti-TNF biologics, throughout pregnancy when indicated.
- IBD management in pregnancy should focus on disease control, nutrition, medication continuity, and coordinated GI-obstetric care.
Liver Disorders
Pregnancy-related liver disease includes hyperemesis-associated liver abnormalities, intrahepatic cholestasis of pregnancy, preeclampsia-related liver injury, HELLP syndrome, and acute fatty liver of pregnancy, as well as preexisting liver disease.
Clinical points
- Interpret liver tests in pregnancy within the clinical context because abnormal results may reflect pregnancy-specific liver disease, preeclampsia-spectrum disease, infection, gallstones, drug injury, or chronic liver disease.
- Acute fatty liver of pregnancy is rare but potentially life-threatening and usually requires urgent delivery-centered multidisciplinary management.
- Recent FIGO and AGA guidance emphasize structured evaluation of jaundice, transaminitis, coagulopathy, and hepatic failure in pregnancy.
Cholestasis
Intrahepatic cholestasis of pregnancy typically presents with pruritus and elevated bile acids and is associated with increased fetal risk at higher bile acid levels.
Clinical points
- Evaluation centers on symptoms, bile acids, liver tests, and exclusion of other liver disease.
- SMFM guidance addresses bile acid testing, ursodeoxycholic acid use for maternal symptoms, fetal surveillance practices, and delivery timing by severity.
- More recent discussions increasingly distinguish mild from more severe bile acid elevation when estimating fetal risk.
Pancreatitis
Acute pancreatitis in pregnancy is uncommon but important, often related to gallstones or hypertriglyceridemia, and requires coordinated medical and obstetric management.
Clinical points
- Suspect pancreatitis in severe epigastric pain radiating to the back, nausea, vomiting, and elevated pancreatic enzymes.
- Gallstones and hypertriglyceridemia are key causes to evaluate in pregnancy.
- Management priorities include IV fluids, pain control, nutritional planning, cause-directed treatment, and escalation for severe disease.
General Resources
Additional current resources and related Perinatology navigation.