Upper abdominal pain in pregnancy may indicate pre-eclampsia.

Pre-eclampsia is one of the prime causes of maternal and perinatal morbidity and mortality. The syndrome is highly variable, and the clinical presentation is often atypical. We describe the case histories of three women who presented with epigastric pain as the first outward manifestation of the disorder and in whom the diagnosis was initially overlooked. A 28 year old primigravida attended her general practitioner's surgery at 34 weeks' gestation with pain in the right upper quadrant, nausea, and vomiting. An antacid was prescribed for presumed reflux oesophagitis. Her blood pressure was not measured and her urine was not tested for protein. The symptoms persisted, and five days later she presented to the hospital antenatal clinic. On examination her blood pressure was 140/80 mm Hg and urine analysis showed proteinuria (2+). She had appreciable tenderness of the right hypochondrium. Further investigation disclosed a moderate thrombocytopenia (56x109/l) and raised serum concentrations of aspartate aminotransferase (225 U/l) and uric acid (0.37 mmol/l). Concentrations of haemoglobin, urea, alkaline phosphatase, and albumin all lay within the normal ranges for pregnancy. There was no evidence of haemolysis, and the standard clotting times were not prolonged. A midstream urine sample was clear of white and red cells at microscopy. Pre-eclampsia with raised liver enzyme concentrations and a low platelet count was diagnosed. As the cervix was unfavourable caesarean section was performed to deliver …