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
I suggest US examination. I'll add a gynaecological and surgical consultation to consider next steps.
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.
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.
RR
17 /min
HR
110 /min
SpO2
98 %
BP
101/73 (82) mmHg
EKG
rythm: sinus
action: regular
frequency: 110 bpm
Examination
PMH: tonsillectomy as a child without complications. PA, AA, EA: 0
Physical examination: subfebrile (37.4 ° C), 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.
CRP 57 mg/L, urea 8,4 mg/dL, creatinine 0,7 mg/dL
Glycaemia
Gly
4,4  mmol/L
Arterial blood gas
pH
7,4
pCO2
42  torr
pO2
82,5  torr
BE
0,1  mmol/l
HCO3
24,5  mmol/l
Complete blood count
HGB
118  g/L
HTC
0,45
ERC
4,5  x1012/L
LEU
15,7  x109/L
PLT
250  x109/L
Biochemical analysis
Na
130  mmol/L
K
4,4  mmol/L
Cl
102  mmol/L
Mg
1,1  mmol/L
Ca
2,3  mmol/L
P
1,2  mmol/L
Glycaemia
Take a sample
Arterial blood gas
Take a sample
Complete blood count
Take a sample
Biochemical analysis
Take a sample