Chapter 14 – Acute Pelvic Pain and Other Gynaecological Emergencies

Acute pain

Causes of acute pain in the context of a positive pregnancy test may include:

ectopic pregnancy pregnancy of unknown location miscarriage red degeneration of fibroid (where a fibroid outgrows its blood supply and undergoes necrosis)

Causes unrelated to pregnancy include:

pelvic inflammatory disease haemorrhage, torsion or rupture of ovarian lesion rupture of acute degeneration of uterine fibroid dysmenorrhoea endometriosis ovarian hyperstimulation in a woman undergoing fertility treatment

Non-reproductive tract causes include:

urinary tract infection pyelonephritis renal calculi diverticulitis appendicitis(2, 3)

Table 14.1 Common causes of low abdominal (pelvic) pain in women of reproductive age

DIFFERENTIAL DIAGNOSIS TYPICAL PRESENTATION FINDINGS THAT SUPPORT THE DIAGNOSIS  DEFINITIVE DIAGNOSTIC FINDINGS MEDICAL EMERGENCIES  Ectopic Pregnancy  Pelvic pain and/or bleeding in the first trimester (typically 6 to 8 weeks) Pain may localise to one side  Positive pregnancy test  Empty uterus on ultrasound  Ectopic pregnancy identified on imaging and/or laparoscopy  Appendicitis Acute onset (hours to days) Migration of pain from peri umbilicus to RIF Systemic symptoms present: anorexia, nausea, vomiting Migration of pain from umbilicus to right iliac fossa Onset of pain not associated with menses McBurney’s point site of maximal tenderness Appendicitis confirmed on imaging, laparoscopic and/or histological findings Ovarian cyst complications (rupture/

torsion) Sudden onset of unilateral pelvic pain, more common in the right iliac fossa  May be associated with vaginal bleeding Adnexal mass felt on bimanual examination  Ruptured ovarian cyst identified on imaging and/or laparoscopy  OTHER CAUSES PID1  Typical pain: 

Onset days to weeks and ... Buy now

Ectopic pregnancy

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Pregnancy of unknown location

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Pelvic inflammatory disease

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Ovarian cyst-related presentations

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Fibroid-related presentations

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Ovarian Hyperstimulation Syndrome

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