Dyspepsia associated with pregnancy is so common that it seems unusual to consider it as an isolated symptom requiring further evaluation or treatment. This discussion is directed toward health care workers who provide acute care in ambulatory settings and would first encounter pregnant patients with significant dyspepsia. The conservative posture is taken that a complaint must be of significant severity or duration to be treated in the pregnant patient.

Predisposition to dyspepsia happens when gastric volume increases after meals; when gastric contents are close to the gastroesophageal junction, such as when recumbent or bending over; and when gastric pressure is elevated, such as with obesity, ascites, tight-binding girdles, and pregnancy.

Underdiagnosis of nonobstetric abdominal disease in pregnancy occurs for a variety of reasons. High hormonal levels during pregnancy can slow down gastrointestinal motility and alleviate or otherwise modify common symptoms. In the late second and third trimester, gastrointestinal organs are displaced upward, changing mechanical features and making examination more difficult. There is a general reluctance to perform invasive tests, radiographic studies, and endoscopic procedures on pregnant patients. The goals of accurate early diagnosis and treatment of gastritis and ulcer disease in pregnancy are to relieve pain and suffering, to prevent potentially morbid complications of ulcer disease, and to prevent the need for surgical intervention during pregnancy and the perinatal period.<sup>68 Palade V., Barcan N., Corneliac V. , et al. Term pregnancy, a factor favoring the bleeding of a gastroduodenal ulcer: A case report Chirurgia 1998 ;  93 : 353-354

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Approximately 1 in 250 to 500 pregnancies is complicated by a nonobstetric surgical problem. Delayed surgical intervention increases prenatal and maternal morbidity and mortality. Although appendicitis is the most common nonobstetric surgical emergency,<sup>3 Andersen B., Nielsen T.F. Appendicitis in pregnancy: Diagnosis, management and complications Acta Obstet Gynecol Scand 1999 ;  78 : 758-762  [cross-ref]

Cliquez ici pour aller à la section Références</sup> ulcer disease can also cause life-threatening bleeding and peritonitis. Peptic ulcer disease is the cause of 50% of upper gastrointestinal tract bleeding. The risk of such bleeding increases with Helicobacter pylori infection and nonsteroidal anti-inflammatory drug (NSAID) use. The timely diagnosis of acute nonobstetric disease is difficult early in pregnancy owing to overlap of symptoms with what is common and late in pregnancy owing to altered abdominal examination. The combination of physical assessment and clinical judgment remains more important for accurate early diagnosis than laboratory and other procedures. Herein, it is assumed that the “surgical abdomen” will eventually manifest separately from heartburn, gastritis, and ulcer disease based on the severity and duration of symptoms.<sup>21 El-Amin A.M., Yahia A.M., Zaki Z.M. , et al. Acute abdomen during pregnancy Int J Gynaecol Obstet 1998 ;  62 : 31-36

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