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.