Pelvic pain and venous congestion revisited: examining relationship between chronic pelvic pain and uterine venous size and blood flow.
blood supply
color Doppler
pelvic pain
ultrasonography
uterus
venous congestion
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
revised:
16
10
2022
received:
24
02
2022
accepted:
07
11
2022
medline:
5
4
2023
pubmed:
28
11
2022
entrez:
27
11
2022
Statut:
ppublish
Résumé
To investigate the relationship between increased uterine venous plexus diameter and chronic pelvic pain in women attending a gynecology clinic. This was a retrospective study of patients attending a tertiary university hospital in London, UK. Women presenting to the gynecology clinic undergoing transvaginal ultrasound examination were recruited into the study. The largest trunk of the uterine venous plexus was measured on each side. Blood flow within the uterine veins was categorized into continuous or interrupted flow and evaluated using color and spectral Doppler ultrasound during normal respiration and on Valsalva maneuver to demonstrate the presence of venous reflux. The largest uterine vein diameter and its blood flow were used for the analysis. The main variables of interest were chronic pelvic pain, uterine vein diameter and type of blood flow. We included 1500 women in the study, of whom 584 (38.9% (95% CI, 36.5-41.5%)) reported chronic pelvic pain. Dysmenorrhea was the most common type of pelvic pain. Age (P < 0.001), menopausal status (P = 0.02), varicose veins (P = 0.01), adenomyosis (P < 0.001) and endometriosis (P < 0.001) were found to be independently associated with the occurrence of pain on multiple logistic regression analysis. There was no difference in uterine vein diameter between women with and those without pain (P = 0.10). Neither uterine vein diameter (P = 0.47) nor type of blood flow (P = 0.07) was significantly associated with the occurrence of pelvic pain on multiple logistic regression. Our findings show that uterine vein diameter is not associated with pelvic pain. However, we found other important clinical and demographic factors that are associated with chronic pelvic pain. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
526-532Informations de copyright
© 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Latthe P, Latthe M, Say L, Gülmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006; 6: 177.
Royal College of Obstetricians and Gynaecologists (RCOG). The Initial Management of Chronic Pelvic Pain (Green-top Guideline No. 41). RCOG Press: London, UK, 2012.
Possover M, Khazali S, Fazel A. Pelvic congestion syndrome and May-Thurner syndrome as causes for chronic pelvic pain syndrome: neuropelveological diagnosis and corresponding therapeutic options. Facts Views Vis Obgyn 2021; 13: 141-148.
Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol 1988; 95: 153-161.
Meissner MH, Khilnani NM, Labropoulos N, Gasparis AP, Gibson K, Greiner M, Learman LA, Atashroo D, Lurie F, Passman MA, Basile A, Lazarshvilli Z, Lohr J, Kim MD, Nicolini PH, Pabon-Ramos WM, Rosenblatt M. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord 2021; 9: 568-584.
Taylor HC Jr. Vascular congestion and hyperemia; their effect on function and structure in the female reproductive organs; the clinical aspects of the congestive-fibrosis syndrome. Am J Obstet Gynecol 1949; 57: 637-653.
Beard RW, Highman JH, Pearce S, Reginald PW. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet 1984; 2: 946-949.
Park SJ, Lim JW, Ko YT, Lee DH, Yoon Y, Oh JH, Lee HK, Huh CY. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol 2004; 182: 683-688.
Koo S, Fan CM. Pelvic congestion syndrome and pelvic varicosities. Tech Vasc Interv Radiol 2014; 17: 90-95.
Amin TN, Wong M, Pointer S, Goodhart V, Bean E, Jurkovic D. Reference ranges for uterine vein dimensions in non-pregnant women with normal pelvic organs. Ultrasound Obstet Gynecol 2019; 54: 403-411.
Amin TN, Wong M, Foo X, Pointer S-L, Goodhart V, Jurkovic D. The effect of pelvic pathology on uterine vein diameters. Ultrasound J 2021; 13: 7.
Champaneria R, Shah L, Moss J, Gupta JK, Birch J, Middleton LJ, Daniels JP. The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess 2016; 20: 1-108.
Hansrani V, Dhorat Z, McCollum CN. Diagnosing of pelvic vein incompetence using minimally invasive ultrasound techniques. Vascular 2017; 25: 253-259.
Amin T, Cohen H, Wong M, Goodhart V, Pointer S-L, Jurkovic D. The prevalence of incidental uterine venous plexus thrombosis in women attending a gynecology clinic. J Thromb Haemost 2020; 18: 2557-2565.
National Institute for Health and Care Excellence (NICE). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline [NG 193]. https://www.nice.org.uk/guidance/ng193.
The Royal College of Radiologists. Ultrasound training recommendations for medical and surgical specialties (3rd edn). Royal College of Radiologists: London, UK, 2017.
Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod 2012; 27: 3432-3439.
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, Exacoustos C, Installe AJ, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Goncalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48: 318-332.
Mavrelos D, Cohen H, Pateman K, Hoo W, Foo X, Jurkovic D. Diagnosis of uterine vein thrombosis on transvaginal ultrasound. Ultrasound Obstet Gynecol 2013; 42: 480-483.
Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Ashraf Mansour M, Baker WH. Definition of venous reflux in lower-extremity veins. J Vasc Surg 2003; 38: 793-798.
Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, Bush RL, Blebea J, Carpentier PH, De Maeseneer M, Gasparis A, Labropoulos N, Marston WA, Rafetto J, Santiago F, Shortell C, Uhl JF, Urbanek T, van Rij A, Eklof B, Gloviczki P, Kistner R, Lawrence P, Moneta G, Padberg F, Perrin M, Wakefield T. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord 2020; 8: 342-352.
Gültaşli NZ, Kurt A, Ipek A, Gümüş M, Yazicioğlu KR, Dilmen G, Taş I. The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women. Diagn Interv Radiol 2006; 12: 34-38.
Bora A, Avcu S, Arslan H, Adali E, Bulut MD. The relation between pelvic varicose veins and lower extremity venous insufficiency in women with chronic pelvic pain. JBR-BTR 2012; 95: 215-221.
Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab FD. A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLoS One 2019; 14: e0213834.
Malgor RD, Adrahtas D, Spentzouris G, Gasparis AP, Tassiopoulos AK, Labropoulos N. The role of duplex ultrasound in the workup of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2014; 2: 34-38.
Hiromura T, Nishioka T, Nishioka S, Ikeda H, Tomita K. Reflux in the left ovarian vein: analysis of MDCT findings in asymptomatic women. AJR Am J Roentgenol 2004; 183: 1411-1415.
Nascimento AB, Mitchell DG, Holland G. Ovarian veins: magnetic resonance imaging findings in an asymptomatic population. J Magn Reson Imaging 2002; 15: 551-556.