What causes severe abdominal pain in pregnancy?

Some pain follows stretching ligaments, constipation, trapped wind, or contractions. Infection of the urine or kidneys can cause abdominal or back pain with burning urination, fever, or chills. Appendicitis, gallbladder disease, and bowel conditions can also occur during pregnancy.

Ectopic pregnancy can cause one-sided pain, bleeding, dizziness, or shoulder-tip pain early in pregnancy. Later, placental abruption may cause sudden pain with bleeding or a tense, tender womb. Pre-eclampsia and HELLP syndrome can cause upper-right abdominal pain, headache, visual changes, swelling, nausea, or feeling very unwell. Preterm labour may cause repeating cramps, pelvic pressure, or fluid leakage.

Severe or persistent pain needs same-day maternity assessment, especially when its cause is unclear. Note when it began, where it is, whether it comes in waves, and whether bleeding, fluid leakage, fever, vomiting, urinary symptoms, or reduced fetal movement is present. Do not take new medicines without checking that they are suitable in pregnancy.

Call emergency services for severe worsening pain, fainting, heavy bleeding, shoulder-tip pain, difficulty breathing, fever with illness, a rigid or very tender abdomen, or reduced fetal movement. Urgent review is also needed for severe headache, visual disturbance, sudden swelling, or upper abdominal pain. Do not wait for a routine appointment.

Which causes fit the timing and location of my pain? Do I need an ultrasound, urine test, blood tests, or fetal monitoring? What symptoms should prompt me to return urgently?