The Pregnant Peritonitis

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  • The gravid uterus can mask the signs of peritoneal irritation (guarding, rigidity and rebound tenderness) by preventing the inflamed organ from contacting the peritoneum.
  • Due to increased white blood cells that naturally occur during pregnancy, leukocytosis is not helpful in identifying acute pathology.
  • A relative increase in blood volume can delay the development of tachycardia and hypotension in the truly ill patient.
  • Consider appendicitis in the patient complaining of typical signs and symptoms of appendicitis even if confounded by right middle and upper quadrant abdominal pain, pyuria, urinary symptoms and subtle signs of peritonitis.
  • HELLP syndrome is managed with blood pressure control, prevention of seizures, correction of coagulopathy, and delivery of the fetus.
  • Radiological investigations, including abdominal plain films, can be safely undertaken during pregnancy and should always be considered so as to avoid delays and failures in diagnosing potentially life-threatening conditions.

 

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HELLP Syndrome

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  • Any pregnant lady in late second or third trimester C/O malaise – Think HELLP (BP may be normal)
  • Treatment of HELLP syndrome is seizure prevention with MgSO4 and controlling BP
  • Getting OBGYN involved early is important to decide on the deļ¬nitive treatment
  • HELLP by itself is not an indication for LSCS unless there are co-existing materal/fetal indications/distress