Role of Ultrasound in the Assessment and Differential Diagnosis of Pelvic Pain in Pregnancy

Abstract

Pelvic pain (PP) is common in pregnant women and can be caused by several diseases, including obstetrics, gynaecological, gastrointestinal, genitourinary, and vascular disorders. Timely and accurate diagnosis as well as prompt treatment are crucial for the well-being of the mother and foetus. However, these are very challenging. It should be considered that the physiological changes occurring during pregnancy may confuse the diagnosis. In this setting, ultrasound (US) represents the first-line imaging technique since it is readily and widely available and does not use ionizing radiations. In some cases, US may be conclusive for the diagnosis (e.g., if it detects no foetal cardiac activity in suspected spontaneous abortion; if it shows an extrauterine gestational sac in suspected ectopic pregnancy; or if it reveals a dilated, aperistaltic, and blind-ending tubular structure arising from the cecum in suspicious of acute appendicitis). Magnetic resonance imaging (MRI), overcoming some limits of US, represents the second-line imaging technique when an US is negative or inconclusive, to detect the cause of bowel obstruction, or to characterize adnexal masses.

Pelvic Pain in Reproductive Age: US Findings

“…US approach of gonadic vein thrombosis combines TSA-US and TSV-US. The latter is referred to the US method to explore the intere gonadic vein decourse and it is performed through transverse and longitudinal scans of the retroperitoneum showing an avascular structure with a tortuous tubular appearance, with adjacent anechoic or hypoechoic areas without any flow detection on the colour Doppler evaluation (Table 13) [46]. CT or MRI, both with contrast medium, should be carried out in the event of an uncertain diagnosis and to assess the extent of thrombosis (Figure 16).…”

Role of Ultrasonography in Evaluation of Various Causes of Pelvic Pain in First Trimester of Pregnancy

“…Because of the fast change in uterine size, the development of associated theca lutein cysts, or ovarian torsion caused by theca lutein cysts, a molar pregnancy can induce pelvic pain [10]. Imaging has come to play a critical role in clinical presentation of evidence for timely treatment and diagnosis, which is perilous to the welfare of the foetus and mother [11,12]. Based on the incidence of chronic pelvic pain, several causes had been identified during early pregnancy.…”