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*Unpublished data.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.