#77 Cramping in Pregnancy

The most common cause of cramping in pregnancy would be stretching of the uterus or what are called round ligaments to accommodate a growing baby. The second most common cause of cramping during pregnancy would be miscarriage or a threatened miscarriage. The third most common cause would be infection. There are, of course, non-uterine causes for cramping, which would include large and small bowel gas, or infection, which could be associated with pregnancy.

Cramping associated with a growing uterus or round ligament pain in early pregnancy is quite common. In my experience, more than 90 percent of mothers have this cramping. In the second trimester, cramping might be associated with miscarriage or round ligament pain. In the third trimester it might be round ligament pain, baby’s movements or just practice labor pains or early labor.

There are several aspects to the work up of pregnancy cramping in early pregnancy. Certainly, a doppler can be used to listen to a baby’s heartbeat. Secondly, an ultrasound can be performed which will allow visualization of the baby’s heartbeat and also provide some idea as to the location of the baby and the placenta within the uterus. Thirdly, a pelvic exam can be done to assess the opening and thinning of the cervix. If there’s thinning of the cervix and no heartbeat, a miscarriage is likely. If on the other hand, there is a heartbeat, but the cervical opening is thin, then the cause for the miscarriage needs to be sought. This would most often be a subtle infection, like mycoplasma or ureaplasma or one of less subtle infections like chlamydia or gonorrhea. In the process of examining the cervix, care should be taken to avoid breaking the amniotic sac and endangering the pregnancy. Most of these infections can be identified by a urine sample.

Treatment for cramping depends on the reason for the cramping. If it is just normal, healthy stretching, there’s nothing to do and the problem will resolve in time. If the cramping is due to infection, then rapid treatment with antibiotics is the treatment of choice. If, on the other hand, cramping is threatened miscarriage, the cause should be looked for. Sometimes women may have a clotting disorder that needs to be defined and specific treatment needs to be undertaken usually with Lovenox or a related blood thinner.

No matter what your history, if you suspect a miscarriage, a trip to the doctor is needed to determine whether or not you should have specific treatment to prevent a miscarriage. If you have had a cervical, vaginal, uterine, or tubal infection, you may need to be re-diagnosed, and re-treated. If on the other hand, you have a history of a bleeding or clotting disorder, you should receive treatment with Lovenox before you have cramping, and a threatened miscarriage.