الفهرس 
INTRODUCTION
Definition of chronic pelvic painOnly 14 pages are availabe for public view
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Abstract
chronic pelvic pain is a disabling and distressing condition as it diminishes the quality of life of CPP patients. (Yosef A et al, 2016).
Despite the magnitude of this problem, chronic pelvic pain remains a poorly understood and difficult-to-treat condition that often results in surgical intervention.
Chronic pelvic pain is a multifactorial condition and therefore, quite often, poorly managed. (Engeler D, 2013).
The present study was conducted in outpatient clinic of Women’s Health Hospital. Assuit University at the period between August-2016 and April-2017.
The study was designed to assess the value of TVS in prediction of the etiological factors of CPP in comparison to laparoscopic findings.
Patients were allocated to one of the following two groups:
group A: Patients with chronic pelvic pain defined by ACOG, 2004 as noncyclic pain that lasts six months or more; is localized to the pelvis, the anterior abdominal wall at or below the umbilicus, or the buttocks; and is of sufficient severity to cause functional disability or require medical care.
group B: (control group) Patients without chronic pelvic pain underwent laparoscopy for infertility.
The inclusion Criteria: The study included patients complained of chronic pelvic pain.
The exclusion Criteria: were current pregnancy, acute pelvic infection or proved chronic bowel, urinary or psychological diseases.
The study Patients were evaluated by complete history taking & physical examination.
The study patients were evaluated by Transvaginal Ultrasound examination. The ultrasound scan result were initially reported as normal or abnormal based on presence or absence of any structural abnormality e.g. an endometrioma or hydrosalpinges. These conventional findings termed as hard markers for pelvic pathology. (Okaro E et al, 2006).
The pelvis was also assessed by TVS for the presence or absence of the soft markers included: Site-specific pelvic tenderness, ovarian mobility or Presence of loculated peritoneal fluid in the pelvis. The Ultrasound scan results were initially reported as abnormal if pelvic tenderness detected, limited ovarian mobility or presence of loculated peritoneal fluid in the pelvis.
Laparoscopy was done; a thorough, standardized examination was performed for diagnosis of any pathological lesion.
The operation findings were correlated with the ultrasound hard &soft markers.
The primary Outcome of this study was assessment the value of TVS in predicting the etiology of CPP in comparison to laparoscopic findings.
Secondary outcome was identification of diseases that more diagnosed with CPP patients.
The results showed that:
Pelvic endometriosis &pelvic adhesions were the most common laparoscopic finding in patients with chronic pelvic pain.
The current study compared pathological lesions diagnosed by TVS & laparoscopy. Results showed that endometriomas, polycystic ovary, ovarian cyst and hydrosalpinges diagnosed by ultrasound were confirmed at laparoscopy, while TVS couldn’t diagnose pelvic endometritotic spots, pelvic adhesions, tubal block and subserous fibroids.
The use of hard markers alone in chronic pelvic pain patients resulted in a high false-negative rate. This is because peritoneal adhesions, endometriosis and tubal block are generally not detected.
The diagnostic accuracy of ultrasound hard markers examination of chronic pelvic pain was (30%), increased to (80%) by addition of ultrasound soft markers examination.