Introduction
Unexplained abdominal pain in pregnancy is common. While many find this
pain trivial, for some it is severe and prolonged. Our 2020 in-hospital
audit of the obstetric emergency department revealed that non-visceral
abdominal pain accounted for 3.4% of all presentations that year*.
‘Round Ligament Pain’ (RLP) has been described as one of the commonest
ailments of pregnancy. This abdominal pain has been traditionally
attributed to the stretching of the uterine round ligaments during
pregnancy. There is little anatomical support for this idea, as there is
only one branch of the genitofemoral nerve running through the ligament.
It is routinely ligated at hysterectomy with no recognised sequelae. RLP
is described in medical textbooks such as the Oxford Handbook of
Obstetrics and Gynaecology (1). However, apart from occasional mentions
in review articles (2-4) and a description of helpful stretches to
alleviate RLP(5) it is nowhere to be seen in peer-reviewed English
Language scientific literature. A search through online databases
PubMed, Google Scholar and the Cochrane Central Register of Controlled
Trials yielded no other results.
*Unpublished data.
Abdominal Wall Pain (AWP) and its subgroup of Anterior Cutaneous Nerve
Entrapment Syndrome (ACNES) are easily diagnosed and immediately
treatable pathologies (6). It is thought to account for 10% of chronic
abdominal pain in the outpatient setting and has a reputation in the
literature for being underrecognised (7). The aetiology is that the
thoracic and anterior cutaneous nerves make 90° turns through the
posterior abdominal wall sheath in fibrous rings to provide cutaneous
sensation to the midline anterior abdomen. Irritation or entrapment of
these nerves provokes pain (7).
As the growing gravid uterus exits the pelvic cavity at 12 weeks’
gestation, it is logical that a pain condition related to the
displacement of the nerves of the abdominal wall could be provoked by a
distending pregnant abdomen. To date, only single case reports of AWP in
pregnancy have been published (10-12). We are currently writing a case
series of the successful treatment of 19 pregnant patients at our
hospital with AWP over the last 18 months.
Objective 1. Determine the proportion of participants experiencing pain,
having knowledge of RLP and the source of that information. Objective 2.
Describe whether participants’ pain fit any of the ten descriptors for
AWP, which were then ranked according to their frequency of clustering
with other descriptors.