Lower Abdominal Pain in Women

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

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

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 a d m i s s i o n a n d / o r 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 forPID.
• 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