The role of ultrasound in the management of the acute gynaecological abdomen

Transvaginal ultrasound has an established role in the assessment of gynaecological patients in almost all areas of the speciality. The incorporation of ultrasound into the initial assessment of the patient presenting acutely with suspected gynaecological pathology, provides an effective and rapid means of diagnosis. This will ideally take place within a dedicated ‘emergency gynaecology unit’, with the gynaecologist performing the ultrasound as an extension of the main clinical examination.

The majority of these women, will be premenopausal. In the absence of a positive urinary pregnancy test, the main distinction that needs to be made is the presence, or not, of a pelvic mass. Transvaginal ultrasound has an established role in the characterization of adnexal masses and their differentiation from leiomyomas, and we will provide an overview of the ovarian, tubal and uterine pathology which may give rise to acute onset symptoms. The presence of adnexal pathology may be coincidental, as the ovary will naturally exhibit a wide variety of cyclical changes, and pain mapping, using the transvaginal probe, will help confirm this.

When considering adnexal torsion, a high degree of clinical suspicion should be maintained as there are no pathognomonic features on ultrasound alone. Even the detection of blood flow within a mass suspected of torsion, using colour Doppler, will not exclude the diagnosis.

By adopting a problem orientated approach to acute pelvic pain, ultrasound can facilitate a rapid diagnosis of most gynaecological problems, and allow appropriate and timely surgical intervention, conservative management or referral to other specialities as indicated.