Chapter 14 – Acute Pelvic Pain and Other Gynaecological Emergencies


There are several acute gynaecological emergencies which can present with sepsis. Prompt recognition and treatment of the source is essential.

PID and tubo-ovarian abscess – severe PID may involve peritonitis, tubo-ovarian abscess and sepsis. Tubo-ovarian abscess may occur in up to one-third of patients admitted with PID.(23) Pelvic ultrasound has high sensitivity and specificity for diagnosis of tubo-ovarian abscess.(23) These appear as multiloculated complex masses with internal debris, septations, irregular thick walls and increased vascularity. They are often bilateral and tender to probe pressure.(15) It is thought that 60-80 per cent of tubo-ovarian abscesses can be managed conservatively with analgesia, intravenous fluids and parenteral antibiotics, however those with abscess rupture, peritonitis and sepsis require urgent surgical management and delay can be fatal.(23) Septic abortion – refers to an abortion or miscarriage accompanied by an intrauterine infection. Septic abortion is less common in women with spontaneous miscarriage compared with termination of pregnancy. Whilst rare, it can be severe and life threatening. Management includes assessment for haemodynamic stability, administration of broad-spectrum intravenous antibiotics and surgical evacuation of any retained products of conception.(24) Bartholins abscess – this is a perineal abscess that ... Buy now