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Acute Pelvic Pain

Clinical Evaluation

Assessment of acute pelvic pain should determine the patient's age, obstetrical history, menstrual history, characteristics of pain onset, duration, and palliative or aggravating factors.

Associated symptoms may include urinary or gastrointestinal symptoms, fever, abnormal bleeding, or vaginal discharge.

Past Medical History. Contraceptive history, surgical history, gynecologic history, history of pelvic inflammatory disease, ectopic pregnancy, sexually transmitted diseases should

Social History. Current sexual activity and

Method of Contraception

Acute Pelvic Pain Inflammatory disease Acute Pelvic Pain Inflammatory disease Acute Pelvic Pain Inflammatory disease

Risk Factors for Acute Pelvic Inflammatory Disease. Age between 15-25 years, sexual partner with symptoms of urethritis, prior history of PID.

Physical Examination pelvic pain, pelvic inflammatory disease, ectopic, tubal pregnancy

Fever, abdominal and pelvic pain, pelvic inflammatory disease, ectopic, tubal pregnancy pelvic tenderness, or peritoneal signs should be sought.

Vaginal discharge, cervical erythema and discharge, cervical and uterine motion tenderness, or adnexal masses or Pelvic Pain, Pelvic Inflammatory disease, ectopic tenderness should be noted.

Laboratory Tests

Pregnancy testing will identify pregnancy-related causes of 

Complete Blood Count. Leukocytosis suggest an inflammatory process; however, a normal white blood count occurs in 56% of patients with PID and 37% of patients with 

Urinalysis. The finding of pyuria suggests urinary tract infection. Pyuria can occur with an inflamed appendix or from contamination of the urine by vaginal discharge.

Testing for Neisseria gonorrhoeae and Chlamydia trachomatis are necessary if PID is a possibility.

Pelvic ultrasonography is of value in excluding the diagnosis of an ectopic pregnancy by demonstrating an intrauterine gestation. Sonography may diagnose acute PID, torsion of the adnexa, or acute appendicitis.

Diagnostic laparoscopy is indicated when acute pelvic pain has an unclear diagnosis despite comprehensive evaluation.

Differential Diagnosis of Acute Pelvic Pain

Pregnancy-Related Causes. Ectopic pregnancy, spontaneous, threatened or incomplete abortion, intrauterine pregnancy with corpus luteum bleeding.

Gynecologic Disorders. PID, endometriosis, ovarian cyst hemorrhage or rupture, adnexal torsion, Mittelschmerz, uterine leiomyoma torsion, primary dysmenorrhea, tumor.

Nonreproductive Tract Causes

Gastrointestinal. Appendicitis, inflammatory bowel disease, mesenteric adenitis, irritable bowel syndrome, diverticulitis.

Urinary Tract. Urinary tract infection, renal calculus.

Approach to Acute Pelvic Pain with a Positive Pregnancy Test

A. In a female patient of reproductive age, presenting with acute pelvic pain, the

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