Lower Abdominal Pain in Women

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CLINICAL DESCRIPTION

It may be a serious condition  

Notes:

  • Not every woman with lower abdominal pain has PID.
  • Be sure to exclude any conditions which require immediate surgical or gynecological treatment

 CLINICAL FEATURES

SIGNS AND SYMPTOMS
  • Fever, abnormal vaginal discharge, cervical motion tenderness, and often adnexal tenderness or masses on bimanual examination.
  • Signs and symptoms of acute illness requiring immediate gynaecological/surgical attention:
    • Missed or overdue or delayed period; delivery or miscarriage; abnormal uterine bleeding; abdominal guarding or rebound tenderness; active vaginal bleeding.
INVESTIGATIONS
  • High vaginal swab culture and sensitivity

TREATMENT

NON-PHARMACOLOGICAL 
  • If the patient has a missed/overdue period or abnormal vaginal bleeding:
    • Check vital signs

•

Do a urine pregnancy test

•

Offer analgesia

•

Consider admission and/or referral if necessary

N.B. When referring, ensure patient's general condition is stable

  • If the patient is very ill, bleeding heavily or in shock:
    • Set up an iv drip and commence resuscitation
  • If the patient does not have missed/overdue period or abnormal vaginal bleeding but does have any of the following:
    • Recent delivery; Recent/suspected miscarriage; Rebound tenderness; Abdominal guarding
  • If at the health centre Give first dose of treatment for PID.
  • Refer immediately for hospital admission after resuscitating the patient should this be required.
PHARMACOLOGICAL 

If at the hospital, admit if the patient: is obviously sick; is pregnant; vomits oral medication or if adequate follow-up care cannot be provided.

  • If the patient does not have missed/overdue period or  abnormal  vaginal  bleeding  and does not have any  of  the  signs/symptoms listed above but does have cervical excitation tenderness or fever:
    • Give Ceftriaxone 250mg IM stat,
    • Give Azithromycin 1g orally as single dose and  
    • Give Metronidazole 400mg 12 hourly for 10 days.
    • Remove IUCD if any and offer other means of contraception
    • Treat partner for gonococcal and chlamydial infection as described above  
    • Review patient after 72 hours:
  • If improved, complete 10-day course of treatment for PID
  • If not improved, refer for gynaecological or surgical consultation
  • If the patient does not have missed/overdue period or abnormal vaginal bleeding and does not have any of the signs/symptoms listed above, and does not have cervical motion tenderness or fever:
    • Determine whether the patient has any other genitourinary complaint/syndrome and manage as per appropriate syndrome:
    • Ask her to return if the abdominal pain persists