Main Findings
The majority of our participants had experienced unexplained abdominal pain in pregnancy, often for prolonged periods of time. The finding that participants with unexplained abdominal pain in pregnancy had an odds ratio of 9.23 to have been told about RLP by a medical carer than those without pain strongly suggests that the conciliatory tale of RLP is still commonly told in clinical practice, despite there being no supportive evidence.
When describing their pain, 98.6% of participants used descriptors for AWP. The commonest AWP descriptor used by participants used was ‘pain worsened by walking, bending, moving to sit’. When examining patients with suspected AWP, Carnett’s test is essential. This involves deep palpation to the painful area of the abdomen while the patient moves from lying to sitting or does a straight leg raise. The test is positive if the pain is exacerbated.
Most participants used multiple AWP descriptors, with a mean number of 4.06/10. The AWP descriptors our participants used that were associated with the most clustering with others was ‘pain worsened by lightly pushing on the affected area’ and ‘when in pain, sensation over the painful area feels different’. This can be elicited on exam where patients find that their pain is triggered by light touch, or that the sensation of ice applied to area feels altered.
While this study was not designed to diagnose our participants as having AWP, it does complement the theory that AWP is likely more common than is currently appreciated in obstetrics. We have labelled the process Pregnancy-Related Abdominal Wall Neuropathy (PRAWN). In the 18 months since we learned of AWP, we have successfully diagnosed and treated 19 pregnant patients with PRAWN with transabdominal plane (TAP) blocks – an immediately effective and diagnostic analgesia that can be long-lasting.