Right Upper-Quadrant Pain in a Pregnant Woman

Demetrius L. Woods II, MD, MPH

Disclosures

August 07, 2012

Clinical Presentation

A 29-year-old G4P1 Ab2LC1 woman at 39 weeks 1 day who has had prenatal care at an outside facility presents to the labor and delivery unit with painful contractions. She also reports abdominal pain and nausea lasting several weeks. Her symptoms began 4 weeks ago with pain that is localized to the right upper quadrant, fever, and intermittent nausea. The patient is not experiencing headache, visual disturbances, leakage of fluid, or vaginal bleeding.

The following are noted on physical and pelvic examination:

  • Vital signs: heart rate, 99 beats/min; respiratory rate, 16 breaths/min; blood pressure, 124/78 mm Hg;

  • Abdomen: mild, diffuse tenderness to palpation; no rebound or guarding;

  • Sclerae: nonicteric;

  • Sterile vaginal examination: 6 cm/75%/-1;

  • Fetal status: reassuring, with a reactive nonstress test and normal amniotic fluid; and

  • Presentation: cephalic.

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