Comparative Study between Clinical and Ultrasound Diagnosis of Emergency of Gynecology
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- Category: Vol. 86, June 2018
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Comparative Study between Clinical and Ultrasound Diagnosis of Emergency of Gynecology, HEND E. HASBY, ASHRAF E. GHARIEB and AHMED M. HAGRAS
Abstract
Background: Acute pelvic pain accounts for up to 40% of the visits to gynecological emergency departments and may indicate a serious condition. Potentially life-threatening gynecological emergencies are acute pelvic conditions that may spontaneously evolve into a life threatening situation. They may also carry a risk of sequelae (organ failure or organ removal) or death in the absence of prompt diagnosis and treatment.
The most common gynecological emergencies are ruptured ectopic pregnancy, adnexal torsion, and complicated pelvic inflammatory disease (tubo-ovarian abscess (TOA) and pyos-alpinx). Missing these high-risk conditions may delay treatment that could lead to potentially negative patient outcomes.
Methods: This study was carried out over 1 year from September 2016 to September 2017 on 30 female patients. The records of all patients were review and data were collected prospectively. Our study included patients presented to the Emergency Department with gynecological emergencies.
These gynecological emergencies included patients pre-sented with acute pelvic pain (e.g. ectopic pregnancy, torsion ovarian cyst, rupture ovarian cyst, pelvic inflammatory disease, tubo-ovarian abscess (TOA), and acute salpingitis) and/or vaginal bleeding (e.g. rupture uterus, and uterine tumors).
Results: Ectopic pregnancy was the most common gyne-cological emergency seen in our study (about 46.67% of patients). Other diagnosis found in this study were adnexal torsion (about 16.67%), ovarian cyst rupture (about 13.33%), PID (about 13.33%), and uterine mass (about 10%).
In this study, only about 53.33% of patients were diagnosed clinically before ultrasound was done. About 93.33% of patients were diagnosed after assessment by ultrasonography. There was statistically significant difference between clinical diagnosis and diagnosis after ultrasonography. (p<0.05).
According to this study, there was a significant difference between clinical and radiological diagnosis using ultrasonog-raphy in diagnosis of ectopic pregnancy, adnexal torsion, and ovarian cyst rupture. (p<0.05).
According to our data, physical examination cannot be used alone to safely rule out a surgical emergency in a woman presenting with acute pelvic pain. This suggests the benefit of adding bedside ultrasonography in the first-line diagnostic management of suspected gynecological emergencies.
Conclusion: Adding Ultrasonography as a bedside test was found to be superior to physical examination in diagnosis of acute pelvic pain. If a gynecologic disorder couldn't be confirmed, or the sonographic finding are equivocal, Multi-Detector Computed Tomography (MDCT) is another imaging choice.
Ultrasound is generally accepted as the first imaging modality used in patients with acute pelvic pain. The true value of ultrasound in acute pelvic pain lies in its ability to detect gynecologic disorders.