Pain in the right upper quadrant (RUQ) during pregnancy is common. While some discomfort is benign and part of the body’s adjustments, other times it signals a condition requiring medical attention. Understanding potential reasons helps pregnant individuals navigate symptoms.
What is Right Upper Quadrant Pain in Pregnancy?
The right upper quadrant (RUQ) is the upper right section of the abdomen, from the ribs to the navel. It contains organs like the liver, gallbladder, parts of the stomach, duodenum, pancreas head, right kidney, and sections of the large and small intestines. Pain here can stem from issues with these organs or surrounding tissues.
Pregnancy contributes to RUQ discomfort due to physiological changes. The expanding uterus displaces internal organs, causing pressure or stretching in the upper abdomen. Hormonal fluctuations also impact digestive processes, contributing to pain.
Everyday Reasons for Discomfort
Common, less serious RUQ pain is often normal in pregnancy. Indigestion and heartburn are frequent culprits; hormonal changes relax the esophageal sphincter, allowing stomach acid reflux, and the growing uterus puts pressure on the stomach. This causes a burning sensation or discomfort.
Rib pain or costochondritis occurs as the rib cage expands and the uterus exerts upward pressure. Round ligament pain, usually felt in the lower abdomen, can radiate higher due to generalized pressure and stretching of ligaments. Increased progesterone levels slow the gastrointestinal tract, leading to gas and bloating, which can cause RUQ pain.
Important Medical Conditions to Consider
Beyond routine discomfort, several medical conditions can cause RUQ pain during pregnancy, requiring prompt evaluation. Gallstones (cholelithiasis) are more common due to hormonal changes affecting bile composition and gallbladder emptying. This causes sudden, severe, cramp-like pain, often after fatty meals, which may radiate to the shoulder.
Preeclampsia, a serious pregnancy complication with high blood pressure and protein in the urine, can also cause RUQ pain from liver swelling. This pain is felt under the ribs on the right side and can signal HELLP syndrome, a severe form of preeclampsia involving hemolysis, elevated liver enzymes, and low platelet count. Acute Fatty Liver of Pregnancy (AFLP) is a rare but severe liver condition occurring in the third trimester, also presenting with RUQ pain. Urinary tract infections (UTIs) ascending to the kidneys (pyelonephritis) can cause flank pain radiating to the RUQ, accompanied by fever and back pain.
When to Seek Immediate Medical Help
Recognize symptoms that warrant immediate medical attention for RUQ pain during pregnancy. Severe or worsening pain not subsiding with rest or position changes requires prompt evaluation. Pain with fever, chills, or persistent nausea and vomiting also indicates urgent care.
Other red flag symptoms include:
Yellowing of the skin or eyes (jaundice), suggesting liver issues.
Severe headaches not improving with medication.
Vision changes, such as blurred vision or flashing lights.
Sudden swelling in the face, hands, or feet, which can be signs of preeclampsia.
Any RUQ pain with vaginal bleeding, contractions, or a general feeling of severe illness also requires immediate medical consultation.
How Doctors Diagnose and Treat
When a pregnant individual experiences RUQ pain, healthcare providers begin with a thorough medical history and physical examination. They inquire about the pain’s nature, duration, intensity, and any accompanying symptoms. This initial assessment helps narrow down potential causes.
Diagnostic tests determine the underlying reason for the pain. Blood tests (e.g., liver function tests, complete blood count) provide insights into organ health and inflammation. Urine tests detect urinary tract infections. Ultrasound is a safe first-line imaging option in pregnancy, visualizing organs like the gallbladder and kidneys without ionizing radiation. If ultrasound findings are inconclusive, MRI may be used, offering detailed views. Treatment for RUQ pain depends on the diagnosis, ranging from dietary adjustments for indigestion to specific medications or, in rare instances, hospitalization and more intensive interventions for serious conditions.