OP17.05: Predictive value of a normal transvaginal ultrasound scan in excluding significant pelvic pathology in women with history of chronic pelvic pain

To assess the value of pelvic ultrasound scan in excluding pelvic pathology in women with history of chronic pelvic pain. Women with history of chronic pelvic pain were examined by transvaginal ultrasound scan. A negative ultrasound scan was defined by the absence of any morphological abnormalities of the uterus and the ovaries, which could have been responsible for chronic pain. In addition the pelvic organs had to be freely mobile and non-tender on palpation with the ultrasound probe. Women who were not reassured by normal ultrasound findings were offered a diagnostic laparoscopy. The prevalence of pelvic abnormalities at laparoscopy was compared to the laparoscopic findings in healthy parous women undergoing laparoscopic sterilisation. In those patients with positive findings at laparoscopy the AFS classifications were used to assess the severity of pelvic adhesions and endometriosis. 24/88 (27%) women with chronic pelvic pain and negative ultrasound findings had evidence of pelvic pathology at laparoscopy. 10/88 (11%) had endometriosis, which was classified as minimal to mild in all cases. 14/88 (16%) had pelvic adhesions, which were mild to minimal in 10 cases and moderate to severe in the remaining four women. 3/55 (5.5%) of the healthy women undergoing sterilization were found to have pathology, including two cases of endometriosis (one minimal and one moderate) and one of minimal pelvic adhesions, which was significantly less than in women with pelvic pain (p < 0.01). The negative predictive value of ultrasound examination for the exclusion of pelvic pathology was 94.5% and the negative likelihood ratio was 0.248. Nearly one third of women with chronic pelvic pain and negative ultrasound scan had evidence of pelvic abnormalities on laparoscopy, however, severe abnormalities were found in less than 5% of cases.