A prospective cross-sectional observational study of acute pelvic pain in gynaecology

Background: The diagnosis of acute pelvic pain is challenging and is based on clinical history, symptoms, physical examination and radiological findings. The various causes of acute pelvic pain may be gynecological, obstetrical, urological or gastrointestinal which can sometimes present with overlapping features and is difficult to diagnose. Objectives were to study the etiology of acute pelvic pain among different age groups and to study the mode of diagnosis of patients. 3)To study the mode of management. Methods: This is a prospective non-interventional cross-sectional observational study where patients presenting with acute pelvic pain of less than 3 months duration fulfilling the criteria of the study were included and analyzed. The sample size was 210. Results: 35.7% patients belonged to age group of 23-32 years while 13% patients belonged to age group 43 and above. 47% cases presented with acute pain for less than 10 days. 13.8% of the patients were pregnant when they presented with pain. 24% cases reported vaginal bleeding with acute pelvic pain and only 10 patients presented with fever. The 18 patients were diagnosed with ruptured tubal ectopic pregnancy and 1 patient had scar ectopic pregnancy. 22 patients had ovarian torsion. Seven patients had complex adnexal cyst and 10 had tubo-ovarian mass. 6 cases of hematometra, 2 of pyometra, 1 of bicornuate uterus with hematometra and 2 of uterine horn collection were observed. The 17 patients had no gynaecological cause of pain. The 73.8% patients had undergone surgical management for acute pelvic pain while17.6% were managed medically. In 8.1% cases medical management was followed by surgical management. Conclusions: Ruptured tubal ectopic, ovarian torsion, ovarian cyst and pelvic inflammatory diseases were the most common causes. Detailed history, examination and radiological studies are equally important in the diagnosis of acute abdominal pain. Early diagnosis is critical to prevent significant morbidity and mortality.