Abstract
A pain score is being used to monitor women with a history of chronic pelvic pain. The total score for each day of the month is plotted into a graph and is later correlated to patient's daily activities in order to help with the diagnosis of baseline gynecological conditions.
Introduction
Chronic pelvic pain (CPP) is a common gynecological problem. It is estimated that it affects 1 in 7 women in the US between 18-50 years of age. 1 There is no community based study of the prevalence of CPP in the UK, but the prevalence rate for CPP in a single study of women undergoing laparoscopy for sterilization or investigation of infertility was 37%. 2 There is no data in Brazil of the prevalence of CPP. According to the Minister of Health in 1997 there were over 1.8 million gynecological consultations requiring special diagnostic procedures and 292,450 hospital admissions for gynecological problems in women aged 15 to 69 years. An unknown proportion of these procedures were related to CPP.
Several studies have shown that CPP can reduce the quality of life and general well-being of women. It has been related to psychosocial problems as well as to the presence of many organic disorders. 1,2 However, complaint is highly influenced by woman's recall and perception of pain and discomfort. This delays correct diagnose and treatment and may lead to unnecessary diagnostic procedures such as laparoscopy.
A new approach to CPP in outpatient clinics is being used to monitor on a daily basis information on sexual life and other potentially important factors and the occurrence of pain measured with a score composed of 4 items: intensity, duration, medication use and constraints to life routine. Patients are required to take home two tables and a graph and fill them daily for at least one month (Figure 1). Every morning they respond about the day before and indicate the presence of any of the nine factors listed: sexual life on previous day (sexual arouse, intercourse, orgasm), menstrual cycle, emotional changes, physical exercises, intestinal functioning, vaginal discharge and temperature. In a second table, the four-level score is given to classify and describe any pelvic pain in the previous day. Absence of pain counts zero and severe pain counts 3 points to the final score. Duration of pain, use of analgesic drugs and degree of constraint imposed by the pain to daily activities are all measured in the same way. Finally, these scores are added up and the total for each day is transferred into a graph so that at the end of a month we can have the pain cycle.
Comments
The pelvic pain scale allows the doctor to examine pain oscillation in relation to basic and personal factors that might shed light into the underlying cause of the pain, give clue to possible etiologic factors and reduce diagnostic costs. The pelvic pain scale can also help during treatment monitoring the effect of medical procedures on pain score and comparing them in a time series for the same patient. Another advantage of the pelvic pain scale is to increase woman's self awareness of possible psychological problems that might interfere with symptoms and response to treatment. Willingness to cooperate is itself an indicator of patient's real interest to cooperate during treatment.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy