Managing Complications in Pregnancy and Childbirth: - IAWG

S-118 Abdominal pain in early pregnancyMANAGEMENTOVARIAN CYSTSOvarian cysts in pregnancy may cause abdominal pain due to torsion orrupture. Ovarian cysts most commonly undergo torsion and ruptureduring the first trimester.• If the woman is in severe pain, suspect torsion or rupture. Performimmediate laparotomy.Note: If findings at laparotomy are suggestive of malignancy (solidareas in the tumour, growth extending outside the cyst wall), thespecimen should be sent for immediate histological examinationand the woman should be referred to a tertiary care centre forevaluation and management.• If the cyst is more than 10 cm and is asymptomatic:- If it is detected during the first trimester, observe for growthor complications;- If it is detected during the second trimester, remove bylaparotomy to prevent complications.• If the cyst is between 5–10 cm, follow up. Laparotomy may berequired if the cyst increases in size or fails to regress.• If the cyst is less than 5 cm, it will usually regress on its own anddoes not require treatment.APPENDICITIS• Give a combination of antibiotics before surgery and continue untilthe woman is postoperative and fever-free for 48 hours (page C-35):- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours.• Perform an immediate surgical exploration (regardless of stage ofgestation) and perform appendectomy, if required.