Skip to main content
  1. Right Decisions
  2. Maternity & Gynaecology Guidelines
  3. Gynaecology
  4. Back
  5. Gynaecology guidelines
  6. Acute Pelvic Pain, Initial Management (312)
Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. 

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Acute Pelvic Pain, Initial Management (312)

Please report any inaccuracies or issues with this guideline using our online form

Background
Pelvic pain is a common reason for women to present as an emergency to Gynaecology. Symptoms of pelvic or abdominal pain have significant overlap with symptoms of non-gynaecological conditions such as appendicitis. Liaison with other specialities may therefore be appropriate. Other specialities may not recognise atypical presentations of ectopic pregnancy and all women of reproductive age who present with abdominal or pelvic pain should have pregnancy testing performed.

Some women will require hospitalisation for assessment due to the severity of their symptoms. However where a patient is clinically stable it may be more appropriate to offer urgent out-patient assessment within Early Pregnancy Assessment Units or an Emergency Gynaecology Service.

Gynaecological causes of Acute Pelvic Pain

  • Ectopic Pregnancy
  • Miscarriage
  • Ovarian Cyst Accident (torsion, rupture,haemorrhage)
  • Mittelschmertz (Ovulation pain)
  • Pelvic Inflammatory Disease. See guideline – GG&C PID Guideline
  • Dysmenorrhoea
  • Exacerbation of Endometriosis

Assessment of the patient with acute pelvic pain

Clinical history

It is important to take an accurate history including –

  • Age and parity (particularly previous ectopic pregnancies)
  • LMP
  • Pain- onset, duration, site, radiation, nature, severity, exacerbating and relieving factors.
  • Associated symptoms- vaginal bleeding, vaginal discharge, bowel and urinary symptoms.
  • Menstrual and contraceptive history.
  • Previous gynaecological and obstetric history.

‘Red Flag’ Symptoms

  • Episodes of collapse.
  • Shoulder tip pain.
  • Significant exacerbation of pain with movement.
  • Fever and Rigors

Examination

  • Temperature, pulse, blood pressure, respiration rate and oxygen saturation
  • Abdominal examination.
  • Speculum and bimanual examination.

Investigations

Initial Investigations

  • Urinary pregnancy test
  • Urine dipstick.
  • Midstream specimen. Send for culture if dipstick positive for protein, nitrites or leucocytes.
  • Swabs for Chlamydia and Gonorrhoea if clinical suspicion of pelvic infection. See guideline – GG&C PID guideline
  • Full blood count and C-reactive protein.
  • Serum HCG if suspicion of ectopic pregnancy

Subsequent Investigations

  • Ultrasound- transvaginal where possible. Women who are not suitable for transvaginal scanning should be asked to attend with a full bladder.

Indications for Immediate Hospital Admission

  • Persistent tachycardia (pulse >100)
  • Hypotension
  • History of collapse
  • Severe pain
  • Signs of peritonism
  • Temperature over 38oC

If Severe Symptoms, consider

  • IV access and fluids
  • FBC and Group and retain
  • Sepsis 6 Protocol
  • Analgesia
  • Nil by mouth
  • Senior review

If stable / mild symptoms

Women who are stable/have mild symptoms can be discharged with an urgent outpatient review. They should be offered simple analgesia and given instructions to return if their symptoms deteriorate.

Editorial Information

Last reviewed: 05/06/2018

Next review date: 30/04/2023

Author(s): Catrina Bain.

Approved By: Gynaecology Clinical Governance Group

Document Id: 312

References

Management of Ovarian Cysts in Premenopausal Women RCOG Green Top Guideline Number 62. November 2011.

Diagnosis and Management of Ectopic pregnancy. RCOG Green Top Guideline 21 November 2016