Armando Hasudungan
Biology and Medicine videos

Acute Pelvic Pain

Rule out pregnancy in an fertile female presenting with acute pelvic/abdominal pain!

Overview Pelvic pain of sudden onset. Of women of reproductive age it is a ectopic pregnancy until proven otherwise. Refer immediately to gynaecology all patients with a pelvic mass, abnormal cervix, or persistent bleeding

Definition
Chronic pelvic pain (CPP): refers to pain of at least six months’ duration that occurs below the umbilicus and is severe enough to cause functional disability or require treatment.
Acute pelvic pain: generally defined as pain in the lower abdomen or pelvis lasting less than three months. In women, it can pose a challenging clinical scenario in which history and physical examination findings are often nonspecific, and the clinical presentation of each condition can vary widely.

Differential Diagnosis

Acute pelvic pain – Gyaenacological

  • Ectopic pregnancy
  • Miscarriage
  • Ovarian cyst rupture
  • Ovarian torsion
  • Ovarian haemorrhage
  • Fallopian torsion
  • Endometritis
  • Pelvic Inflammatory Disease
  • Mittelschmerz

Acute Pelvic Pain – Non-Gyaenacological

  • Appendicitis
  • Urinary stones
  • Urinary Tract infection
Remember In a pregnant woman these differential will be different as the pain might be due to the obstetric complications
Side note In Adolescents don’t forget transverse vaginal septum and imperforate hymen
Think In postmenopausal women who present with acute pelvice pain, ectopic pregngnacy and ovarian torsion is unlikely

Chronic Pelvic Pain will be discussed elsewhere
More info on Chronic Pelvic Pain

DIFFERENTIAL DIAGNOSIS OF ACUTE PELVIC PAIN
Condition History Examination
Ectopic Pregnancy Nausea, vaginal bleeding Adnexal mass, hypotension
Miscarriage vaginal bleeding
Ovarian torsion Nausea, vomiting, radiation of pain to groin, right sided or left sided pelvic pain
Ovarian cyst Dyspareunia, left sided pelvic pain, Hypotension (ruptured left cyst) Adnexal mass
Endometriosis/endometritis Dysmenorrhoea, Dyspareunia Adnexal mass
Pelvic inflammatory disease Bilateral pelvic pain, Dysuria, Vaginal Discharge Adnexal mass, bilateral adominal examination, cervical motion, uterine or adnexal tenderness, Fever, vaginal discharge
Appendicits Nausea, vomiting, pain migration from periumbilical to RLQ of abdomen Fever, RLQ pain
Urinary tract infection Dysuria, Gross haematuria, Urinary Frequency Fever
Urinary stones left sided pelvic pain, Gross haematuria, radiation of pain to groin
Think Life threatening causes of pelvic pain are ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, appendicits and PID

Evaluation and Approach

  • History
  • Examination
  • Psychological Assessment
  • Investigations
    • β-hCG
    • FBC, group and save – if ectopic suspected
    • ESR/ CRP
    • Urinary/serum hCG
    • MSU
    • Triple swabs – STI?
    • Pelvic USS
    • Abdominal X-ray
    • CT
    • MRI
    • Diagnostic laprosocopy
Remember β-hCG to rule out pregnancy

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