What Causes Upper Right Abdominal Pain in Preeclampsia?

When preeclampsia causes pain in the upper right side or upper middle of your stomach (epigastric area), it is a warning sign that the condition is affecting your liver ^[1][2]. Severe preeclampsia and a related condition called HELLP syndrome cause inflammation and poor blood flow within the liver, causing it to swell ^[3][1]. Because the liver is enclosed in a thin, tight sac called Glisson’s capsule, this swelling stretches the capsule to its limits, resulting in severe, unrelenting pain just under your right rib cage ^[1][2].

The Mechanism Behind the Pain

Preeclampsia is driven by systemic issues with blood vessels (endothelial dysfunction), which limits healthy blood flow throughout the body ^[3][4]. When the small blood vessels in your liver are damaged, it leads to microscopic blood clots and reduced oxygen (ischemia) ^[3][1]. As liver tissue becomes inflamed and damaged, the organ swells ^[1].

The liver itself does not have many pain receptors, but its outer covering—Glisson’s capsule—is highly sensitive to being stretched ^[1][2]. As the liver swells against this capsule, it causes a sharp, constant pain ^[1][2].

Additionally, this pain can sometimes radiate to your right shoulder or upper back ^[5][6]. This happens because the swollen liver or inflamed capsule presses against the diaphragm, irritating a nerve (the phrenic nerve) that shares a pain pathway with your right shoulder ^[5][4].

Telling It Apart from Normal Pregnancy Discomforts

During the third trimester, it can be easy to mistake serious warning signs for normal pregnancy aches. However, liver pain from preeclampsia feels and behaves differently than common complaints:

• Baby Kicks: A foot in the ribs is uncomfortable but usually brief and changes when you or the baby shifts positions. Liver pain is constant and unrelenting ^[7][8].
• Heartburn and Indigestion: Heartburn typically causes a burning sensation that moves up your chest and may respond to antacids or dietary changes ^[7][9]. Upper abdominal pain from preeclampsia is deeper, often described as sharp or aching, and does not go away with antacids ^[7][8].
• Gallbladder Issues: While gallbladder problems also cause pain in the upper right stomach, they frequently occur in waves or spike after eating a fatty meal ^[9]. Preeclampsia-related liver pain is persistent regardless of what you eat ^[7][8].

This pain is also frequently accompanied by other severe signs of preeclampsia, such as a severe headache that will not go away, changes in your vision, or sudden, severe swelling in your face and hands ^[7][8].

Why It Requires Immediate Attention

Upper abdominal pain is classified as a “severe feature” of preeclampsia ^[10][11]. It is a critical warning sign that the disease may be progressing to HELLP syndrome ^[11][12]. HELLP stands for:

• Hemolysis (red blood cells breaking down too quickly)
• Elevated Liver enzymes (a sign of liver damage)
• Low Platelets (cells that help blood clot, increasing bleeding risk)

Ignoring this pain can be dangerous. If the liver continues to swell unchecked, blood can pool beneath the capsule, forming a subcapsular hematoma ^[1][7]. In rare cases, the pressure can cause the liver capsule to rupture—a life-threatening emergency ^[13][5].

However, this is highly preventable when caught early. If you experience new, severe, or persistent pain under your right ribs or upper stomach, do not wait to call a clinic—go directly to the Emergency Room or your hospital’s Labor and Delivery triage ^[14][15].

What to Expect at the Hospital

Going to the hospital allows your care team to step in before dangerous complications arise. When you arrive, you can expect the following steps to ensure both you and your baby remain safe ^[5][6]:

• Fetal Monitoring: Nurses will place monitors on your belly to track your baby’s heart rate and ensure they are not in distress.
• Blood Pressure Management: If your blood pressure is dangerously high, you will be given fast-acting medications to bring it down to a safer level.
• Lab Tests: They will draw blood to check your liver enzymes and platelet counts, giving a clear picture of how much the preeclampsia is affecting your organs.
• Making a Delivery Plan: Depending on how far along you are and the results of your tests, the safest option for both you and your baby may be to deliver. Delivery is the only definitive cure for preeclampsia and HELLP syndrome.