Preeclampsia is a serious pregnancy-related condition characterized by high blood pressure and signs of damage to other organs, usually after 20 weeks of gestation. While many symptoms exist, a particular type of upper abdominal or rib pain is a significant warning sign that can indicate the condition is worsening. Understanding the nature and location of this pain is important for anyone who is pregnant.
Characteristics of Preeclampsia Upper Abdominal Pain
The pain associated with severe preeclampsia is often mistakenly described as “rib pain” but is generally located in the upper right quadrant (RUQ) of the abdomen or the epigastric area, which is just below the breastbone or sternum. This location corresponds directly to where the liver sits in the body. The pain is typically described as being sharp, intense, and persistent, often feeling like a deep ache or a severe, unrelenting burning sensation.
Unlike temporary discomfort, this pain is constant and does not ease with changes in position, movement, or rest. Some individuals describe it as feeling similar to very severe heartburn that antacids cannot relieve. The pain may also radiate to the back or the right shoulder tip, which is a common pattern for pain originating in the liver. This symptom is often associated with severe forms of preeclampsia, including HELLP syndrome, a life-threatening complication.
The Medical Reason for Severe Pain
The intense upper abdominal pain in preeclampsia is a direct consequence of liver involvement. Preeclampsia can cause swelling, known as hepatic edema, and sometimes small hemorrhages within the liver tissue. The liver is encased in a tight, fibrous membrane called Glisson’s capsule.
When the liver swells rapidly due to fluid retention and damage, this firm capsule stretches. This rapid stretching creates significant tension, which activates pain receptors in the capsule, leading to the severe discomfort felt in the right upper quadrant. This specific type of pain is a sign of liver dysfunction and often correlates with elevated liver enzymes detected in blood tests, confirming damage to the organ.
Distinguishing Preeclampsia Pain from Normal Pregnancy Discomfort
It is important to differentiate the severe pain of preeclampsia from the common aches and discomforts of a normal pregnancy. Many pregnant individuals experience heartburn or acid reflux, which causes a burning sensation in the chest or upper abdomen. However, unlike the pain from preeclampsia, reflux is usually relieved relatively quickly with over-the-counter antacids.
Other benign causes of upper abdominal pain include gas, constipation, or general musculoskeletal strain from the expanding uterus. Pain caused by gas or muscle strain is typically intermittent, shifts location, and often finds relief through movement, passing gas, or changing position. In contrast, preeclampsia pain is characteristically constant, unremitting, and not alleviated by these simple measures.
Musculoskeletal pain from the baby pushing on the ribs is also a common occurrence. This discomfort tends to be felt directly on the rib cage and is generally less severe than the deep, visceral pain that signals liver issues. If pain under the ribs is severe, constant, and accompanied by other warning signs, it should not be dismissed as simple pregnancy discomfort.
Urgent Steps to Take When Pain Occurs
Experiencing new, severe, or persistent pain in the upper right abdomen or epigastric region during pregnancy requires immediate medical attention. If this type of pain develops, you should contact your healthcare provider immediately or go to an emergency room for evaluation. This symptom is a red flag that requires prompt assessment of blood pressure, liver function, and platelet count.
This pain often occurs alongside other signs that signal the condition is worsening, such as a severe, persistent headache that does not respond to pain medication. Other associated symptoms requiring immediate medical attention include sudden changes in vision, such as blurred sight, seeing spots or flashing lights, or sudden, rapid swelling of the face and hands.