Pregnancy, Round Ligament Pain

Round ligament pain in pregnancy is abdominal pain due to stretching of the round ligaments that normally happen during pregnancy.

• Abdominal pain during pregnancy is common. Frequently, it is a result of stretching of the round ligaments. 
• It is most often felt during the second trimester
• Round ligament pain is due to normal physiologic changes that take place as your body is transformed by pregnancy.
• There are other, abnormal, but treatable causes of pain that your health care provider may want to evaluate. Therefore, any new or significant pain should be reported to your doctor.

Round ligament pain refers to a type of cramping caused by stretching of the round ligaments. These ligaments proceed from the front of the uterus. This type of pain occurs more commonly on the right side of the pelvis because the uterus normally rotates to the right as the pregnancy advances.

• The uterus is normally the size of a pear. The two round ligaments are thick bands of fibromuscular tissue which tends to support the uterus within the abdomen. As the uterus grows in size and weight, these ligaments elongate and soften, subsequently stretching and tensing like rubber bands.
• The ligaments pull and tug on nearby nerve fibers and sensitive structures, causing pain. The severity of pain may be worrisome. Although round ligament pain is uncomfortable, it is also very common and generally benign.
• A ligament spasm, an involuntary contraction or cramp, usually triggers a sharp pain. These spasms are found more frequently on the right side than the left because of the normal tendency of the uterus to turn to the right.
• You can awaken at night with pain after having suddenly rolled over in your sleep.
• The pain may also be brought on by exercise.

Pain from stretching uterine ligaments can be severe and can be confused with causes outside your pregnancy. Pregnant women often feel acute abdominal pain when the cause is something more serious, such as the following:

• Appendicitis: An inflammation of the appendix, which is located in the right side of the lower abdomen. You initially have poor appetite, nausea, vomiting, fever, and, as the inflammation progresses, worsening pain. As you move further along in your pregnancy, the pain from appendicitis will be felt in the upper abdomen instead on the lower abdomen because of your growing uterus pushes the appendix upward.
• Ovarian torsion (twisting) or ovarian cysts. The ovary may twist and interrupt its own blood supply, or an ovarian cyst may rupture, causing sudden severe abdominal pain.
• Abnormal growths in the abdominal area
• Twisting of a fibroid tumor (benign), which may interrupt the blood supply to the lesion and causing pain.
• Abdominal cramps due to constipation because of slow digestion caused by pregnancy (These emanate from the ascending colon and/or cecum, located in the right lower quandrant of the abdomen.)

If you have been seen by your doctor and know that your pregnancy is not ectopic in location, not associated with bleeding, and not accompanied by uterine contractions, you are probably experiencing one of the more common discomforts of pregnancy.

• For most women, the pain will go away simply by changing daily activities.
• Except for rare cases, the pain may last throughout the entire second and third trimesters of your pregnancy.
• Once your infant is delivered, the pain usually resolves spontaneously.

Describe your pain, and any other symptoms, to your health care provider, who will assess whether or not to send you to a hospital’s emergency department. Do not hesitate to seek emergency care if any of the following symptoms occur.

• Fever
• Chills
• Painful urination
• Difficulty walking

If you need to go to the emergency department, the emergency doctor will examine you to rule out a life-threatening condition. If you have lower abdominal pain, evaluation of both the abdomen and the pelvis will likely be necessary.

Although the exam may be uncomfortable, important diagnostic physical findings may assist the doctor in deciding which laboratory tests to order. Ultimately this may enhance your doctor’s understanding of your condition and aid in further testing and treatment.

The doctor may also order some basic laboratory tests, which will help to assess the overall health of yourself and that of your baby.

• A complete blood count (CBC) is a blood test that detects anemia or a possible infection. Often, pregnant women will be slightly anemic. Your white blood cell count may be slightly higher than the anticipated normal level seen in a non-pregnant patient.
• A urine sample may be tested. Pregnant women with lower abdominal pain may have a urinary tract infection. This could place you and your unborn baby at risk for severe prenatal complications.
  • Severe flank pain may be associated with the passage of a kidney stone. The finding of blood in your urine may assist in making this diagnosis.
  • The doctor may perform an ultrasound of the pelvis if you are not sure of the exact date when your last period bagan or when you conceived. It may also aid in diagnosing miscarriages and ectopic pregnancies.
    • Ectopic pregnancy remains the most life threatening of disorder of early pregnancy.
    • Ovarian cysts are common in early pregnancy and may rupture or twist. When a cyst ruptures, it frquently releases blood into the pelvis. It may be difficult to distinguish intra-abdominal bleeding due to a ruptured ovarian cyst from due to a ruptured ectopic pregnancy.
    • An ultrasound may occasionally aid in the diagnosis of appendicitis, but frequently a CT ("cat") scan will be necessary to rule out or establish this diagnosis.

After your condition has been evaluated and diagnosed, your health care provider will formulate a treatment plan. If all acute emergencies have been completely ruled out, you may be safely sent home safely with strict instructions for follow-up care.

• You may be advised to return to the emergency department or doctor’s office if your pain worsens or persists despite basic therapy with acetaminophen (Tylenol).
• You may also be asked to modify your daily activity level and avoid positions that may worsen your symptoms.

• Applying heat to the area may relieve the pain.
• Hot soaks or baths may be helpful.
• Lying on the opposite side may also relieve the pain.
• The pain may diminish as your pregnancy progresses.
• Move around carefully—rising or sitting down more gradually, avoiding sudden movement—may decrease the spasms.
• Tylenol usage may alleviate the symptoms (discuss the use of Tylenol with your healthcare professional).

After you have been reassured that you are in sound general health, you should refrain from specific activities that trigger the pain.

Not every woman who is pregnant will experience round ligament pain.

• During pregnancy, you will experience changes in your body. The round ligaments which were thickened band-like structures prior to the pregnancy are now elongated and thinly stretched as they support the uterus.
• This stretching is caused by the release of progesterone and the enlargement of the fetus within the uterus.
• These changes, while natural, are unavoidable. As a result, there are no proven preventive exercise regimens or simple remedy for this pain.