A woman of childbearing age has a pelvic fluid on gynecologic ultrasound during a physical examination, but the report does not clearly diagnose it either. Shouldn’t there be pelvic fluid under normal circumstances? Does the presence of pelvic fluid indicate the presence of pelvic inflammatory disease? Further examination should be done to find the cause of the pelvic effusion, and the cause should be addressed.
According to the causes, pelvic fluid is divided into two categories: physiological and pathological.
I. Physiological pelvic fluid can be found during ovulation and menstruation
Anatomically, the pelvis is in the lowest part of the abdominal cavity. When there is a small amount of exudate, leakage or ruptured bleeding from the pelvic and abdominal organs, the fluid will first accumulate in the pelvis, thus forming pelvic effusion. These conditions are physiological in nature and do not require clinical treatment. For example, in women of normal reproductive age, during ovulation, oocytes, granulosa cells of the oocytes encircling it and follicular fluid are discharged together, resulting in a small amount of pelvic fluid; in a few women, during menstruation, due to contraction of the uterus causing backflow of menstrual blood, a small amount of menstrual blood can flow backwards into the pelvis through the fallopian tubes, forming pelvic fluid.
There are four main causes of pathological pelvic effusion
The common causes of pathological pelvic fluid include pelvic inflammatory disease, tuberculous pelvic inflammatory disease, ectopic pregnancy, and malignant tumors of the ovaries and fallopian tubes.
1.Pelvic inflammatory disease
Pelvic inflammatory disease refers to inflammation of the upper reproductive tract and its surrounding tissues, mainly endometritis, tubal inflammation, tubo-ovarian abscess, and pelvic peritonitis, among which tubal inflammation is the most common and mostly occurs in women of childbearing age.
The symptoms of pelvic inflammatory disease may vary depending on the severity of the inflammation and the extent of the lesion. The main symptoms include lower abdominal pain (one or both sides, may be persistent, aggravated by activity or sexual intercourse), lumbar pain, fever, increased vaginal discharge, etc. If the condition is severe, there may be chills, high fever and other systemic symptoms. The acute inflammatory period is mainly treated with antibiotics and Chinese herbal medicine, and pelvic abscess is not effective for antibiotic treatment, so surgery can be used.
2. Tuberculous pelvic inflammatory disease
Among female genital tuberculosis, tubal tuberculosis is the most common, usually bilateral, with thickened and enlarged fallopian tubes. Tuberculosis of the fallopian tubes is often combined with pelvic peritoneal tuberculosis, and the peritoneum and pelvic organ surfaces are covered with corn-like tuberculosis lesions, producing a large amount of exudate accumulation in the pelvic cavity.
3. Ectopic pregnancy
A fertilized egg that lays outside the body of the uterus is called an ectopic pregnancy, the most common being tubal pregnancy. If the tubal pregnancy miscarries or ruptures, the tubal wall will rupture and bleed, and blood will accumulate in the rectal recess of the uterus and form pelvic fluid. Ultrasonography can only show pelvic fluid and cannot show if the fluid is blood. Patients with ectopic pregnancy mostly have irregular vaginal bleeding, lower abdominal pain and positive urine pregnancy test.
4. Malignant tumor of ovary and fallopian tube
Malignant tumor of ovary and fallopian tube occurs, ascites is usually more. Ultrasound and magnetic resonance examination find occupancy in the adnexal area, and tests such as tumor indicators help in diagnosis and differential diagnosis.
To sum up, if a small amount of pelvic fluid is found by ultrasonography during gynecological physical examination, it can be combined with medical history, symptoms and physical signs in detail to clarify whether the fluid is normal or abnormal. If it is diagnosed as abnormal effusion, the cause of the effusion should be clarified and removal of the cause is the key.
3. 4 common causes of pelvic inflammatory disease
The female reproductive tract has a certain defense function against bacterial invasion. The response to invading pathogens is related to the type, quantity, virulence and immunity of the organism, and only when the balance between bacterial virulence, quantity and immunity of the organism is out of balance does it increase the chance of pelvic inflammatory disease. The common causes of pelvic inflammatory disease are the following.
1, infection after intrauterine surgical operation: abortion, curettage, tubal lavage, hysterosalpingography, hysteroscopy, IUD and IUD removal, if the surgical disinfection is not strict, the original reproductive system infection, post-operative lack of attention to personal hygiene, have sex, etc., can cause the upstream infection of endogenous bacteria in the lower reproductive tract.
2, do not pay attention to menstrual hygiene: during menstruation, the endometrial lining peels off, the blood sinuses in the uterine cavity open, and the presence of clots, which is a good condition for bacteria to breed. If you don’t pay attention to hygiene during menstruation, use sanitary napkins or toilet paper with substandard hygiene standards, or have sex, you will give bacteria the opportunity to infect the pelvis upstream, leading to pelvic inflammatory disease.
3. Direct spread of inflammation from neighboring organs: e.g. appendicitis, peritonitis involves the pelvis through direct spread, etc.
4, puerperal infection: refers to local or systemic infection caused by pathogens attacking the reproductive tract during the puerperium, which may be related to poor hygiene during pregnancy, premature rupture of fetal membranes, severe anemia, obstetric surgical operation, postpartum hemorrhage, etc.