In a pregnant patient presenting with abdominal pain, what should you initially consider?

• A. Contractions until proven otherwise
• B. Appendicitis
• C. Urinary tract infection
• D. Ectopic pregnancy

Answer: (A)

The main idea is to treat labor as the initial working diagnosis whenever a pregnant patient presents with abdominal pain. Contractions are the most common cause of abdominal pain in pregnancy and they have immediate, specific implications for how you manage the patient: you’ll focus on monitoring, preparing for delivery if labor is progressing, and arranging rapid transport to obstetric care.

To assess, ask about the onset, frequency, duration, and intensity of contractions, and whether membranes have ruptured or there is vaginal bleeding. If contractions are regular and progressing, that strongly supports labor and guides your actions. If red flags appear—such as heavy bleeding, signs of fetal distress, or rupture of membranes without prior labor—you’ll adjust accordingly, but labor remains the starting assumption because it’s the most likely and urgent scenario to prepare for.

Other conditions like appendicitis, urinary tract infection, or ectopic pregnancy are important to consider, but they are less likely to be the initial working diagnosis and require different diagnostic considerations. Ectopic pregnancy especially is a critical concern when pain and pregnancy are present, but you start with labor as the default and then evaluate for signs that would point toward a non-labor cause.