Severe lower abdominal pain

[NickB]

Okay, I am on my second week off of orientation in a postpartum unit and had a weird event happen tonight. I had a G2P2 (now) pt who delivered just after midnight this morning. She had a nice delivery from what I understand with a small tear and wasn't really having any pain today. I medicated her with motrin 600 at 1640 for minor cramping and back pain. At 1845, I stopped in to see her before shift change and she was sitting up in her chair and said she needed nothing. At 1905, I was in the middle of report when she called out for her nurse. I stopped and went down to see what she needed and she was still in the chair but complaining of severe abdominal pain and crying. I immediately moved her to her bed, assessed her fundus and checked her to see if she was bleeding. I observed no increase in bleeding, and her fundus was still firm. Her lower abdomen was painful even to touch. I got another nurse to check her with me. We got her up to go to the bathroom and she stated she voided 40 min. prior. My initial thought was hemmorage, but I ruled that out when I checked for bleeding. I then thought that maybe she was trying to pass a big clot, but wasn't so sure as this was my first experience with this issue. Her vitals were stable. We called the MD, who was also unsure, medicated her for pain, and when I left, she was getting ready to have some Ultrasounds done as well as CBC, CMP, and UA C&S. Any ideas or things that I may have not checked. I'm a new nurse and new to this specialty so I was a bit unsure about everything. Thanks.

[cindyloowho]

The pain experienced by your uterus contracting down after giving birth typically increases with each pregnancy. It gets more efficient at contracting down faster and harder and so many women state worse pain than they had with their first children. Don't know that that is what what was going on, but could be very likely if all assessments were WNL.

[DSkelton711]

It doesn't say how much she voided. Maybe she still had a full bladder or something intestinal? Just read about an unfortunate strep infection in a woman that led to quad amputation. Her first symptom was abdominal pain. Glad they were checking her out. Hope she is better.

[NickB]

She was experiencing a normal amount of uterine cramping that's to be expected postpartum with a slight increase while breastfeeding. Again, all normal. She was voiding adequate amounts of clear urine as well. This was acute onset stabbing lower mid-abdominal pain. Pretty different from uterine cramping I have seen in my 3 short months on this unit. That's what caught me offguard.

[LPNnowRN]

Did she have anesthesia? Sometimes that takes a while to wear off and then you get increased pain.

[Elvish, BSN, DNP, RN, NP]

I'd like to throw in ligament pain as a possibility. Pregnancy stretches out the round ligaments, and once she delivers they (along with the uterus) might flop around a bit and she might experience some pretty significant pain from it. Been there, done that...especially this second time around.

Won't hurt to scan her and see if there's anything amiss, though.

[MassED, BSN, RN]

my first thought is gas after you'd ruled out the obvious first threats.

I'm not an OB/or L&D nurse, but after those emergent conditions are ruled out, an obvious one would be gas... especially considering you checked on her while she was sitting on a chair and then a short time later had horrible pain.

Gas is a big problem for many post partum patients...

[DSkelton711]

I thought of gas as well. That can be pretty intense. Original poster: any updates?