الفهرس 
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Abstract
Acute pelvi-abdominal pain in pregnancy refers to pain that occurs during the pregnancy period. It is a major diagnostic challenge to primary care physicians. A diagnosis based solely on the history, physical examination and simple laboratory data is frequently inaccurate. Much of the morbidity and mortality associated with its different causes can be attributed to delay in establishing the correct diagnosis.
The most common urgent causes of acute pelvi-abdominal pain are gynaecologic pregnancy related (abortion, ectopic pregnancy, preterm labor, placental abruption, uterine rupture), or gynaecologic non pregnancy related (adnexal mass, adnexal torsion, uterine leiomyoma, endometriosis, pelvic inflammatory disease), or gastrointestinal (appendicitis, inflammatory bowel disease, intestinal obstruction, gastroesophageal reflux, peptic ulcer disease), or hepatobiliary (HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count), acute fatty liver of pregnancy, cholelithiasis, acute cholecystitis, acute pancreatitis, hepatitis), or genitourinary (hydronephrosis of pregnancy, urolithiasis, pyelonephritis, cystitis) or vascular (ovarian vein thrombosis, mesenteric vein thrombosis, ovarian vein syndrome, aneurysm rupture, vasculitis).
Diagnostic imaging allows rapid and often precise diagnosis, leading to an optimal management, especially allowing efficient triaging of pregnant patients between medical or symptomatic treatment, gynecologic consultation or referral to surgery.
The aim of this study was to assess the role and usefulness of ultrasound modality in the evaluation causes of acute pelvi-abdominal pain in pregnancy.
The present study included fifty patients complaining of acute pelvi-abdominal pain during pregnancy. All patients underwent full history taking and clinical examination, laboratory analysis of urine, complete blood count and imaging evaluation including ultrasound either transabdominal (50 patients) and transvaginal (16 patients).
The patients were followed up (operative data, pathology, clinical &/or imaging follow up) whenever possible.
All patients presented with acute pelvi-abdominal pain as well as other associated symptoms such as: 19 patients presented by nausea, 15 by vaginal bleeding, 15 patients with dysuria, 11 patients with vomiting, five patients with fever and four patients with hematuria .
Laboratory investigations were also performed. Complete blood count was performed for the fifty patients: 37 patients had normal values for pregnancy (74%), 10 had a relatively high leukocyte count values for pregnancy (20%), and three had decreased HB levels in their CBC result (6%).
Also, urine analysis was performed for the fifty patients: 35 patients had normal results (70%), 12 had high pus cells (UTI) (24%), and four had high red blood cells in urine (8%).
The final diagnosis were distributed to 25 gynaecological causes, 15 gynaecologic pregnancy related causes, (six abortion, five ectopic pregnancy (three were tubal while two were heterotopic), three placental abruption (either retroplacental or sub-aminiotic or sub-chrionic), and one hydatiform mole) and 10 gynaecologic non pregnancy related causes,(four fibroids, three adnexal mass (one was dermoid cyst ,the other two were ovarian cysts), two adnexal torsion and one migratory intrauterine contraceptive device).There were 32 non-gynaecological causes, such as six gastrointestinal causes (appendicitis), five hepatobiliary causes (cholecystitis), 21 urological causes (12 urinary tract infection, five hydronephrosis of pregnancy and lastly four urolithiasis).In this study there were seven patients had more than one final diagnosis causing pain.
Ultrasound remains the primary modality by which complaints specific to the pelvis and abdomen are evaluated. Ultrasound examinations have preceded all other imaging modalities when evaluating pelvi-abdominal disorders.