- Ectopic Pregnancy
- Miscarriage
- Ovarian Cyst Accident (torsion, rupture,haemorrhage)
- Mittelschmertz (Ovulation pain)
- Pelvic Inflammatory Disease. See guideline – GG&C PID Guideline
- Dysmenorrhoea
- Exacerbation of Endometriosis
Acute Pelvic Pain, Initial Management (312)
Warning
Please report any inaccuracies or issues with this guideline using our online form
Background
Pelvic pain is a common reason for women to present as an emergency to Gynaecology. Symptoms of pelvic or abdominal pain have significant overlap with symptoms of non-gynaecological conditions such as appendicitis. Liaison with other specialities may therefore be appropriate. Other specialities may not recognise atypical presentations of ectopic pregnancy and all women of reproductive age who present with abdominal or pelvic pain should have pregnancy testing performed.
Some women will require hospitalisation for assessment due to the severity of their symptoms. However where a patient is clinically stable it may be more appropriate to offer urgent out-patient assessment within Early Pregnancy Assessment Units or an Emergency Gynaecology Service.
Clinical history
It is important to take an accurate history including –
- Age and parity (particularly previous ectopic pregnancies)
- LMP
- Pain- onset, duration, site, radiation, nature, severity, exacerbating and relieving factors.
- Associated symptoms- vaginal bleeding, vaginal discharge, bowel and urinary symptoms.
- Menstrual and contraceptive history.
- Previous gynaecological and obstetric history.
‘Red Flag’ Symptoms
- Episodes of collapse.
- Shoulder tip pain.
- Significant exacerbation of pain with movement.
- Fever and Rigors
Examination
- Temperature, pulse, blood pressure, respiration rate and oxygen saturation
- Abdominal examination.
- Speculum and bimanual examination.
Initial Investigations
- Urinary pregnancy test
- Urine dipstick.
- Midstream specimen. Send for culture if dipstick positive for protein, nitrites or leucocytes.
- Swabs for Chlamydia and Gonorrhoea if clinical suspicion of pelvic infection. See guideline – GG&C PID guideline
- Full blood count and C-reactive protein.
- Serum HCG if suspicion of ectopic pregnancy
Subsequent Investigations
- Ultrasound- transvaginal where possible. Women who are not suitable for transvaginal scanning should be asked to attend with a full bladder.
- Persistent tachycardia (pulse >100)
- Hypotension
- History of collapse
- Severe pain
- Signs of peritonism
- Temperature over 38oC
- IV access and fluids
- FBC and Group and retain
- Sepsis 6 Protocol
- Analgesia
- Nil by mouth
- Senior review
Women who are stable/have mild symptoms can be discharged with an urgent outpatient review. They should be offered simple analgesia and given instructions to return if their symptoms deteriorate.