Round ligament pain
Round ligament pain (RLP) is pain associated with the round ligament of the uterus, usually during pregnancy. RLP is one of the most common discomforts of pregnancy and usually starts at the second trimester of gestation and continues until delivery. It usually resolves completely after delivery although cases of postpartum RLP (that is, RLP that persisted for a few days after delivery) have been reported. RLP also occurs in nonpregnant women. The round ligament of the uterus goes from the pelvis, passes through the internal abdominal ring, and runs along the inguinal canal to the labia majora . It is the structure that holds the uterus suspended inside the abdominal cavity. There are at least 2 other round ligaments in the human body, the round ligament of the liver ("ligamentum teres hepatis") and the round ligament of the head of the femur ("ligamentum teres femoris"). Symptoms. The most common symptoms of RLP are: Causes. The pathogenesis of RLP is varied. Although very common during pregnancy, non-gestating women can also experience RLP. The most common causes of RLP are as follows: Diagnosis. Abdominal pains during pregnancy may be due to various pathologies. RLP is one of the most  common and benign of these pains. However, diagnosis of RLP is problematic. Some of the conditions that may present symptoms similar to those of RLP are appendicitis, ectopic pregnancy, kidney stones, urinary tract infection, uterine contractions, inguinal hernia, ovarian cysts, and endometriosis. If abdominal pain is continuous and accompanied by vaginal bleeding, excessive vaginal discharge, fever, chills, or vomiting, then it is most unlikely to be RLP and immediate consultation with a health care provider is warranted. Physical examination, ultrasonography, and blood and urine tests may be able to pinpoint the actual cause of abdominal pain. In some cases, however , RLP was only diagnosed during exploratory surgery. Case reports. In many cases, RLP is confused with other conditions that cause abdominal pain. Described below are some problematic diagnoses related to RLP. A 22-year-old pregnant woman presenting abdominal pains was initially diagnosed with RLP and was discharged. Subsequent symptoms and further tests revealed acute non-perforated appendicitis that required surgery. Appendectomy was successful but premature labor occurred 7 days after discharge, leading to spontaneous abortion. Several cases of varicosity, of the round ligament during pregnancy leading to RLP have been reported although they were frequently misdiagnosed as inguinal hernia . In one case, a woman in the 28th week of gestation developed a lump in the left pubic area. The swelling was prominent when standing but not in the supine position and has a cough impulse. Ultrasonography revealed varicosities on the uterine round ligament. In another case, a woman at 22 weeks gestation was diagnosed with inguinal hernia and underwent surgery. Explorative surgery did not locate a hernia but revealed varicosities of the round ligament. Resection of the uterine ligament was successfully performed and no perinatal and postpartum complications were reported. Several cases of postpartum RLP have been reported. In  one case, a 27-year-old woman presented with abdominal pain 24 hours after normal vaginal delivery. Another case was that of a 29-year-old woman who presented with RLP 3 days after delivery. In both cases, initial diagnosis was inguinal hernia. In the first case, emergency surgery did not locate any hernia but found the round ligament of the uterus to be edematous and filled with thrombosed varicose veins. The thrombosed part was excised and the patient recovered without sequelae. Another case report described a 37-year-old woman presenting with inguinal mass 6 days after normal vaginal  delivery. CT and MRI revealed thrombosed blood vessels along the inguinal course of the uterine round ligament that extended towards the labia majora. Several cases of inguinal endometriosis, that infiltrates the round ligament of the uterus have been reported in fertile, non-pregnant women. In the majority of these cases, diagnosis was problematic. In some cases, definitive diagnosis of round ligament endometriosis was only possible during exploratory surgery. Cases of myoma-like growth occurring on the uterine round ligament have been reported. Gonadotropin stimulation during in vitro fertilization can induce cyst development in certain parts of the female reproductive system . A case report documented the development of a mesothelial cyst on the uterine round ligament of a woman after IVF stimulation. Treatment. Once RLP has been diagnosed, there are many ways to reduce the pain without jeopardizing the pregnancy.