Key distinguishing features of the most common diagnoses
|Abnormal Vaginal Bleeding||Possible||No||Yes||Possible||No|
|Purulent Discharge PV||Yes||No||No||No||No|
|Tender Uterus PV||Yes||No||Possible||No||No|
Likely:HVS, cervical swab, urinalysis, MSU, pregnancy test.
Possible:FBC, ESR/CRP, ultrasound, laparoscopy (all usually arranged by hospital admitting team).
- Urinalysis: Look for nitrites and pus cells to make diagnosis of UTI
- MSU will confirm UTI and guide antibiotic treatment.
- HVS for bacteria including gonococcus and endocervical swab for Chlamydia if purulent discharge present
- ESR/CRP: Elevated in PID.
- Pregnancy test: Positive in ectopic and miscarriage
- FBC: Raised WCC helps confirm PID and UTI if not being admitted. Also elevated in pelvic abscess
- Urgent ultrasound helpful if miscarriage or ectopic pregnancy suspected.
- Cases referred to hospital may undergo laparoscopy.
- In miscarriage, pain follows bleeding. In ectopic pregnancy, the sequence is usually reversed.
- Remember that there may be no bleeding with an ectopic pregnancy – or that the vaginal loss may be a light, blackish discharge.
- PV bleeding will cause haematuria on urinalysis. Only diagnose UTI if the symptoms are suggestive and urinalysis also shows nitrites and pus cells.
- Severe unilateral pain in very early pregnancy suggests ectopic pregnancy, even with no bleeding. Admit urgently.
- If PID does not settle within 48 hours of appropriate antibiotic treatment, consider abscess formation.
- Don’t forget to check femoral and inguinal canals for a possible strangulated hernia.