Case 3: Shooting Leg Pain – Appendicitis or Sciatica of Pregnancy?
Ms. B, a 33 year old G1, P0 at 36 weeks gestation reports for a focus prenatal visit complaining of pain in her right groin and numbness in her right leg.

HISTORY OF PRESENT ILLNESS
Ms. B’s symptoms began two days ago. She took Tylenol for the pain, but had poor relief. She describes the feeling as a shooting pain and numbness down right leg. Ms. B is concerned that this may be early labor or something more serious. She reports consistent fetal movement and no vaginal bleeding.

EXAMINATION
Her vital signs are: BP 110/70mm Hg, pulse 92bpm. On physical exam, the abdomen is normal, no rebound pain, or inguinal adenopathy/tenderness.


Continue Reading

Fundal height: 36cm
FHT: 150 sets
U/A:  negative for blood, leukocytes
Cervical exam showed cervix to be long, thick, closed with a non-tender adnexal area.

ASSSESSMENT & TREATMENT PLAN
A diagnosis of appendicitis must be ruled out. Ms. B could also be suffering from sciatica of pregnancy, which occurs most commonly during the third trimester. Sciatica may be caused by the expanding uterus placing pressure on the sciatic nerve in the lower part of the spine. When the baby begins to shift into the proper birth position, it can rest directly on the nerve and can cause constant or intermittent pain depending on that baby’s position.

A CBC (stat) is ordered to rule out appendicitis. Ms. B is given counseling on safety precautions regarding leg numbness and stability. She is told to rest and consider an abdominal support band. She is told to continue taking Tylenol as needed for the pain.