A 28-year-old G1P0 presents to your office at 18 weeks gestational age for an unscheduled visit secondary to right-sided groin pain. She describes the pain as sharp and occuring with movement and exercise. She denies any change in urinary or bowel habits. She also denies any fever or chills. The application of a heating pad helps allete the discomfo. As her obstetrician, what do you tell this patient is the most likely etiology of this pain?
Correct Answer: Round ligament pain
Description: (Gabbe, 2/e, pp 227. Cunningham, 21/e, pp 43, 1281.) The patient is giving a classic description of round ligament pain. Each round ligament extends from the lateral poion of the uterus below the oviduct and travels in a fold of peritoneum downward to the inguinal canal and inses in the upper poion of the labium majus. During pregnancy, these ligaments stretch as the gravid uterus grows fuher out of the pelvis and can thereby cause sharp pains, paicularly with sudden movements. Round ligament pain is usually more frequently experienced on the right side due to the extrorotation of the uterus that commonly occurs in pregnancy. Usually this pain is greatly improved by avoiding sudden move- ments and by rising and sitting down gradually. Local heat and analgesics may also help with pain control. The diagnosis of appendicitis is not likelybecause the patient is not experiencing any fever or anorexia. In addition, because the gravid uterus pushes the appendix out of the pelvis, pregnant women with appendicitis often have pain located much higher than the groin area. The diagnosis of preterm labor is unlikely because the pain is localized to the groin area on one side and is alleted with a heating pad, which would not be the case with labor contractions. In addition, when labor occurs, the pain would persist at rest, not just with movement. A urinary tract infection is unlikely because the patient has no urinary symptoms. A kidney stone is unlikely because usually the patient would complain of pain in the back, not low in the groin. In addition, with a kidney stone the pain would not only occur with movement, but would persist at rest as well
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Surgery
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