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Obstetrics and Gynecology – Pelvic Pain: By Leslie Po M.D.


Pelvic pain can be differentiated into acute
or chronic pain. Acute pelvic pain is something you must take very seriously. Here are four
conditions that you cannot afford to miss inacute pelvic pain. Number one – Ruptured ectopic pregnancy
Minutes matter here. This is an emergent life-threatening condition where a pregnancy occurs outside
of the uterus. Think of this when a reproductive aged woman presents with sudden onset of acute
pelvic pain and is hemodynamically unstable. This is a clinical diagnosis. Immediate surgical
intervention can prevent severe morbidity and mortality. Number two – Ovarian torsion
Think of this if your patient has acute colicky pelvic pain with nausea and vomiting. It can
be associated with a mild leukocytosis and low-grade fever. A pelvic exam will reveal
an adnexal mass. While this is a clinical diagnosis, doppler ultrasound can be helpful
to assess for arterial blood flow to the ovary. Urgent surgical intervention to detort the
ovary can prevent ovarian necrosis and fertility compromise. Number three – Ruptured ovarian cyst
Think of this if your patient has a sudden acute onset of pelvic pain with a drop in
hemoglobin levels but has a negative urine or serum bHCG. Ultrasound imaging is helpful
to show a hemorrhagic ovarian cyst and blood in the pelvis. If the patient is hemodynamically
stable with stable hemoglobin, she can be managed conservatively with outpatient follow
up. If she is unstable or continues to have a drop in hemoglobin, surgical intervention
may be necessary. Number four – Tuboovarian abscess
Think of this if your patient has a gradual onset of acute pelvic pain with fever, leukocytosis,
nausea and vomiting. Clinical examination will reveal cervical motion tenderness and
adnexal fullness or mass. Ultrasound imaging is helpful to differentiate from pelvic inflammatory
disease. TOA’s are one of the few abscesses that can be treated with parenteral antibiotics.
If medical treatment fails, abscess drainage by interventional radiology or surgical intervention
may be necessary.

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