Minor aches and pains occur with virtually all pregnancies. Lower abdominal pain could arise from the ovaries, although problems involving other structures can mimic ovarian pain. Possible causes include both gynecologic and nongynecologic conditions. Some pose no threat to the pregnancy or the mother while others require urgent medical treatment. Contact your healthcare provider right away if you are pregnant and experience pain in your lower abdominal pain.

Ectopic Pregnancy

A fertilized egg normally implants in the uterine lining. With an ectopic pregnancy, implantation occurs outside the uterus, most commonly in the fallopian tube near the ovary. As the pregnancy progresses, the growing embryo stretches the tube causing pain. An ectopic pregnancy is a medical emergency because a ruptured tubal pregnancy can cause life-threatening bleeding.

Round Ligament Pain

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The round ligaments arise from either side of the uterus, pass near the ovaries and attach to the pelvic wall, helping to hold the uterus in place. As the uterus grows during pregnancy, these ligaments stretch and may cause pain. Round ligament pain -- which is typically sharp and comes on suddenly -- occurs most often during the second trimester. Although decidedly uncomfortable, round ligament pain poses no threat to the mother or baby.

Ovarian Growths

Various types of ovarian growths can potentially cause ovarian pain during pregnancy. Most of these growths are noncancerous and often pose no immediate threat to the pregnancy or the mother.

Functional Ovarian Cyst

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Functional ovarian cysts, which arise from egg follicles, are relatively common during pregnancy, particularly during the first trimester. Most cause no symptoms, pose no threat to the pregnancy and disappear as the pregnancy progresses. Occasionally, a functional ovarian cyst grows large enough to cause pain.

Other Ovarian Growths

After functional ovarian cysts, noncancerous ovarian tumors are the most common type of ovarian growths seen in pregnant women. These growths often cause no symptoms but might cause pain if large. A small percentage of ovarian tumors discovered during pregnancy are cancerous. Ultrasound testing and possibly other imaging or blood tests help distinguish between functional ovarian cysts, other noncancerous ovarian growths and tumors that might be cancerous. Treatment depends on the size of the growth and the probability of it being cancerous.

Ovarian Torsion and Rupture

The size of the mass is an important consideration when deciding how best to manage an ovarian growth during pregnancy. Large growths might rupture and cause bleeding. Sizable growths might also twist, causing loss of blood supply to the affected ovary, a condition known as ovarian torsion. When there is a significant risk of cancer, or ovarian torsion or rupture, surgical removal of the growth might be recommended.

Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is a rare complication of assisted reproductive technology, particularly when human chorionic gonadotropin is used to stimulate maturation of a woman's eggs and ovulation. With this condition, the ovaries enlarge and fill with fluid and the capillaries of the body become leaky. This leads to water leaking into the body tissues, which can cause life-threatening complications. OHSS symptoms include abdominal pain, nausea, vomiting and sudden abdominal swelling due to fluid accumulation. OHSS during early pregnancy requires urgent medical care.

Placental Abruption

Placental abruption refers to premature detachment of the placenta from the uterine wall, which leads to bleeding. Sudden abdominal pain often occurs with this condition, although this symptom might be absent with a small detachment. Placental abruption poses health risks to both the mother and baby and requires emergency evaluation.

Nongynecologic Causes

A wide variety of nongynecologic conditions can cause abdominal pain in pregnancy, just as in people who are not pregnant. A few important examples include:

• Kidney infection
  
• Urinary tract blockage by a stone or the pregnant uterus
• Appendicitis
• Bowel obstruction
• Gallbladder attack

Other Considerations, Warnings and Precautions

There are other possible causes of abdominal pain that can mimic ovarian pain during pregnancy, though they tend to be less common than the conditions discussed. Contact your healthcare provider right away if you are pregnant and experience unexplained abdominal pain, which may or may not be ovarian pain. Seek urgent medical care if you experience any warning signs or symptoms, including:

• Severe or worsening abdominal pain
  
• Fever or chills
• Vaginal bleeding
• Dizziness, lightheadedness or fainting
• Shortness of breath or difficulty breathing
• Sudden increase in abdominal size
• Sudden increase in swelling of hands or feet
• Vision changes
• Persistent, throbbing headache

Reviewed and revised by: Tina M. St. John, M.D.