Sharp pain during pregnancy warrants your attention, but don’t panic. There are many possible culprits for sharp right-sided pain, including both pregnancy-related causes and unrelated conditions. Some causes represent harmless ailments. However, sharp right-sided pain sometimes signals a problem with the pregnancy or another potentially serious medical problem. Contact your healthcare provider right away if you experience sharp pain during pregnancy to determine appropriate next steps.
Early to Middle Pregnancy Conditions
Round ligament pain is a leading cause of sharp, right-sided twinges during pregnancy. The round ligaments, which connect the uterus to the body wall, stretch as the pregnant uterus grows. This can provoke periodic sharp pain near the hip, possibly extending into the groin. Round ligament pain occurs more commonly on the right side due to the position of the uterus as it extends into the abdomen. Stretching, changing positions, sneezing and laughing often provoke the pain. Round ligament pain typically begins in the second trimester but might begin sooner. While uncomfortable, this type of pain does not affect the pregnancy.
Ectopic pregnancy is an important consideration with right- or left-sided lower abdominal or pelvic pain. This condition is a medical emergency and occurs when a fertilized egg implants somewhere other than in the body of uterus. The right or left ovarian tube is the most likely site for an ectopic pregnancy. Pain and other symptoms, such as vaginal bleeding, usually develop within 6 to 12 weeks after conception with a tubal pregnancy. Urgent care is needed to avoid potentially life-threatening complications.
High Blood Pressure in Late Pregnancy
Preeclampsia refers to the new development of high blood pressure in the second half of pregnancy accompanied by other signs and symptoms, such as protein in the urine, headaches, rapid weight gain, and pronounced swelling of the face, hands, feet and legs. Severe preeclampsia can damage the mother's liver and other organs. Liver damage related to severe preeclampsia typically causes persistent pain in the right upper abdomen along with elevated levels of liver enzymes in the blood. Severe preeclampsia with nervous system involvement accompanied by the development of seizures is called eclampsia. Preeclampsia and eclampsia pose potentially serious risks to both the mother and the baby.
Conditions affecting your reproductive organs, but not directly related to your pregnancy, can also cause sharp right-sided pain. A cyst on the right ovary might cause this type of pain if it grows large, bleeds or becomes twisted. Similarly, an existing fibroid located on the right side of the uterus can cause sharp pain if it enlarges and begins to breakdown, a condition known as red degeneration. Although these situations can be frightening when you’re expecting, most women do not experience pregnancy-related complications and go on to experience a successful delivery.
Occasional right- or left-sided abdominal pain during pregnancy may be due to something as simple as constipation or gas pains. Many pregnant women experience constipation due to slowed transit of food through the bowels. Appendicitis is another consideration with right-sided abdominal pain. While pregnancy does not increase the risk for appendicitis, the condition occurs in roughly 1 out of 1,500 pregnancies, according to an October 2010 review article in the "Journal of Ultrasound Medicine." Other examples of intestinal conditions that might cause right-sided abdominal pain during pregnancy include a bowel obstruction, a flareup of inflammatory bowel disease and diverticulitis, among others.
Other Digestive Conditions
Pregnancy increases the risk for gallstones due to high levels of estrogen and progesterone. Symptoms of a gallbladder attack, which can occur anytime during pregnancy, include pain in the upper right abdomen, nausea, vomiting and possibly fever. Acute fatty liver of pregnancy (AFLP) is a rare but serious complication that typically occurs during the third trimester or shortly after delivery. In addition to upper right-sided abdominal pain and tenderness, symptoms include nausea, vomiting, loss of appetite, headaches, fatigue and yellow discoloration of the skin. AFLP requires urgent treatment and delivery of the baby to protect the health of the mother and infant.
Urinary System Conditions
Although pregnancy does not increase the risk for urinary system stones, this common ailment occurs in 1 out of 200 to 1,500 pregnancies, according to a September 2013 review article in the "International Journal of Women's Health." Severe pain typically occurs in the flank area over the site of the stone, which can develop on the right or left side. Blood in the urine and painful urination commonly accompany the pain. Most urinary stones pass on their own, but a stone that fails to pass can lead to preterm labor.
Flank pain also occurs with a kidney infection, or pyelonephritis, which occurs in roughly 1 to 2 percent of pregnancies. Pregnant women are at increased risk for urinary tract infections due to slowed passage of urine from the kidney to the bladder. In addition to one-sided flank pain, common signs and symptoms include fever, chills, frequent and painful urination, and nausea and vomiting. Pyelonephritis usually occurs during the second or third trimester of pregnancy and can lead to preterm labor if not treated promptly.
Warnings and Precautions
While an occasional right-sided twinge may not signal anything of concern, it's best to check with your pregnancy healthcare provider if you experience any abdominal, pelvic or chest pain. In some situations, urgent medical care is necessary. Seek immediate medical evaluation and care if you experience any red-flag warning signs or symptoms, including:
-- severe, persistent or worsening abdominal, pelvic or chest pain
-- cyclic abdominal or back pain that might signal labor
-- vaginal bleeding
-- fever, with or without chills
-- severe headache
-- confusion, agitation or excessive drowsiness
-- blurry vision or spots before your eyes
-- dizziness, lightheadedness or fainting
-- shortness of breath or difficulty breathing
Reviewed and revised by: Tina M. St. John, M.D.