OC31.05: Prevalence of pathology in women presenting with pelvic pain and/or bleeding to an inner London acute gynaecology unit (AGU)

Little information is available about prevalence of pathology among women presenting with acute gynaecological problems. The aim of this study was to look at the prevalence of pathology in women presenting to an AGU with pelvic pain and/or vaginal bleeding. All doctors examining patients were required to complete data sheets about 1000 consecutive women, detailing age, pregnancy, presenting complaints and pathology found on scan. Data sheets were completed for 920/1000 (92%) women. Mean age was 31.2 years (S.D9.81). 542 (58.9%) were pregnant. 89.3% had an intrauterine pregnancy (IUP) and 32 (prevalence 3.5%) had an ectopic pregnancy (EP) visualised on transvaginal scan (TVS). Of these, 18 (56.3%) presented with pain, 10 (31.3%) with pain and bleeding and 4 (12.5%) with only bleeding. The women with pregnancies of unknown location were evenly distributed among the 3 presentations 33 (37.9%) pain, 28 (32.2%) pain and bleeding and 26 (29.9%) bleeding alone. 378 non pregnant women presented to AGU during the study period. 65.1% of those presenting with pelvic pain had a normal TVS. 31 (16.7%) had an ovarian cyst >5 cm diameter, 6 (3.2%) had a tuboovarian abscess, 1 had a pelvic mass and 1 a pelvic abscess. 42% non pregnant women with vaginal bleeding had a normal scan. 15 (21.7%) had significant fibroids, 4 an endometrial polyp and 3 postmenopausal women had thickened endometrium (>5 mm). 54.3% non pregnant women who presented with pain and bleeding had a normal scan. 3 had significant fibroids, 2 an ovarian cyst >5 mm and 1 an early IUP. This is the first study to look at the variety of pathology presenting to an AGU. A 3.5% prevalence of EP emphasises the importance of having an ultrasound scan available at the time of initial consultation. The majority of pregnant women had an IUP and were reassured. Women with pelvic pain and/or bleeding can be efficiently triaged to appropriate management based on ultrasound findings.