Acute pelvic pain

Common presentation Usually considered as pain in the lower abdomen or pelvis of < 3 months Challenging as wide types of pathologies can be responsible Many symptoms and signs are insensitive and non-specific Ectopic pregnancy , pelvic inflammatory disease and ruptured ovarian cyst represent the most common gynaecological causes of acute pelvic pain

History- Use the SOCRATES to get a good history History may not help in reaching a diagnosis but helps in narrowing differentials and to guide further evaluation Think reproductive tr / urinary tr / intestines / PREGNANCY Pregnancy is the single most crucial determinant factor in women of childbearing age Most acute serious pathologies have < 48 hrs of pain Vaginal bleeding / discharge Menstrual history / LMP /Sexual history H/O ectopic H/O uterine fibroids / ovarian cysts Past medical and surgical history Contraceptive history.

Examination / tests- Baseline vital signs Abdominal & pelvic examination Bimanual examination - helpful if PID is suspected and can reveal○ cervical motion tenderness○ uterine or adnexal tenderness Pregnancy test in all sexually active females of reproductive age History and focused US are often more successful in reaching a diagnosis A pelvic examination carries low sensitivity and specificity Ultrasound is generally the...