P29.06: Pelvic pain‐ pressure on our gynaecological services?

Pelvic pain is a common and significant symptom in women of reproductive age requiring prompt diagnosis and treatment. It is traditionally categorised into acute and chronic subtypes. We conducted this study to evaluate the outcome of all women presenting with pelvic pain. This prospective study was conducted in the acute gynecological unit of a busy tertiary care teaching hospital in London with six thousand patients seen annually. The study analyzed various referral pathway sources, presentation and outcome of all patients presenting with acute pelvic pain over three months. A total of 96 patients were seen with symptoms of acute pelvic pain. Average age of patients were 31 years with most common referral from accident and emergency, 78 (81%). 10 women (10.4%) were referred from surgical ward and the remaining three were from gynecological and genitourinary medicine clinic. The presenting symptom in the majority was generalized pelvic pain (42%). 47 of 96 patients (49%) had normal scan findings. Only one patient with normal scan findings needed admission for analgesia. Ovarian etiology predominated among the abnormal scans with hemorrhagic corpus luteal cyst and cyst accidents being the major subtypes. 90% were managed conservatively and only 10% required surgical intervention. 75% were managed on an outpatient basis while 25% required admission. Pelvic pain is a symptom that needs to be evaluated carefully. Interestingly the majority in our study did not have significant abnormality in the scan, which demonstrated that pain is a subjective finding and it's difficult to detect the organic and psychological etiology in each individual. Acute gynecological services with one stop referral clinic could filter most of organic causes of pain offering prompt and efficient services in a cost-effective manner thereby reducing the admissions and the pressure on the services.