An abdominal abscess in pregnancy
In pregnant women there are many special features that must be taken into account in the diagnosis and therapy of abscesses in the abdominal cavity. In principle, both the health of the pregnant woman and the unborn child are exposed to serious risks. The first difficulties already arise when an abscess in the abdomen is detected.
In many cases, symptoms typical of pregnancy mask the symptoms of the actual illness and make it difficult to take a medical history and carry out a physical examination. Laboratory diagnostics are also problematic. An abscess in the abdomen is usually due to a bacterial infection, which is noticeable by the increase in the number of white blood cells (leukocytes) in the blood.
During pregnancy, however, this value is also increased in healthy women, which is why the significance of a laboratory test is reduced. In pregnant women, the concentration of stress hormones (glucocorticoids) in the blood is also increased. In the event of infection, these substances can suppress the protective reaction of the surrounding tissue and contribute to an alleviation of pain symptoms.
During pregnancy it is therefore possible that an abscess in the abdomen is only noticed very late by the person affected. In the case of infections in the abdominal cavity, the strong abdominal wall muscles normally react with severe tension. The physician can thus obtain indications of a serious illness by examining the muscle tension.
In pregnant women, however, the degree of tension of the abdominal wall muscles is reduced from the outset and an infection that spreads in the abdominal cavity does not have to be accompanied by a tense abdominal wall. It should be borne in mind during therapy that any surgical intervention can induce labour. Depending on the maturity of the unborn child, the doctor must decide whether tocolysis (inhibition of labour) or delivery by caesarean section is appropriate.
If there is an abscess in the abdomen, treatment with antibiotics may be necessary. In this case, a careful choice of antibiotics must be made in order not to impair the health of the child. The so-called tetracyclines must not be used during the entire pregnancy.
Metronidazole, which is otherwise commonly used for bacterial infections of the abdominal cavity, should not be used in the first trimester. The prognosis for the child depends on its maturity and the occurrence of any complications. If an abscess in the abdomen causes the pathogens to enter the bloodstream or the placenta to be undersupplied, the life of the unborn child is at serious risk.
Among the abscess diseases in pregnancy, the so-called perityphlitic abscess is worth mentioning. This is an encapsulated accumulation of pus which can form in the case of appendicitis based on a perforated appendix. In women, this abscess can descend into the Douglas cavity, a pocket-shaped cavity between the rectum and uterus, which is the deepest point of the abdominal cavity in the female organism.