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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case described here reports on an extremely unusual complication of induced abortion: the rupture of a benign cystic teratoma with spillage of its contents within the walled-off area of the pelvic cavity, and with subsequent infection culminating in a large pelvic abscess. The patient in question was admitted to the hospital for severe pelvic pain. After colpotomy was performed, a large amount of pus was drained out, and the patient was put on antibiotics. A subsequent laparotomy showed a dermatoid cyst on the right ovary, and it was surgically removed. No further complications were observed.
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PMID:Pelvic abscess and perforation of the sigmoid colon by a segment of benign cystic teratoma: an unusual complication of induced abortion. 67 5

Obstetrician-gynecologists at St. James's University Hospital in Leeds, England, compared various cervical ripening agents in 64 18-39 year old women presenting for first trimester abortion. The women either received oral administration of a placebo or RU-486 or had a laminaria tent or gemeprost vaginal suppository inserted into the endocervical canal or the posterior fornix, respectively. All cervical ripening agents dilated the cervix better than the placebo (p .02). They also greatly diminished the force needed (50-65%) to dilate the cervix to 8 mm Hegar (p .001). The laminaria tent resulted in greater initial cervical dilatation than gemeprost or RU-486, regardless of parity (p .05), but the total force was not significantly different between the 3 groups. 71% of the women who received the gemeprost vaginal suppository had pelvic pain and regular painful uterine contractions. The pain was so intense in 33.3% of them (20% of all gemeprost patients) that health workers had to inject opiate analgesia intramuscularly. 81% of laminaria tent patients experienced menstrual type pains. A significantly lower percentage of RU-486 patients (33%) suffered mild pelvic discomfort than the gemeprost (p = .03) and laminaria tent groups (p = .001). None of the women in the placebo, laminaria tent, and RU-486 groups received analgesia. 40-41% of women in the 3 treatment groups experienced preoperative vaginal bleeding. Since RU-486 patients suffered minimal side effects and insertion of laminaria tents is inconvenient and potentially damaging (e.g. iatrogenic complications of fistulas, dumb belling, and tent fracture), the physicians concluded that RU-486 is the easiest cervical priming agent to administer and is as effective as the other agents.
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PMID:Should we use prostaglandins, tents or progesterone antagonists for cervical ripening before first trimester abortion? 145 95

The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were 5,400 Dkr (approximately pounds 500) in Denmark in 1979. Sequelae of postabortal infection are similar to and occur with the same frequency as sequelae to "spontaneous" pelvic inflammatory disease. Thus, secondary infertility was found in 10% of women with postabortal infection, spontaneous abortion in 22%, dyspareunia in 20%, and chronic pelvic pain in 14%. The risk of ectopic pregnancy is probably also increased. Surgical scrub cannot sterilize the endocervix and, as a consequence, abortion is performed in a contaminated field. The presence of pathogenic bacteria, i.e. Chlamydia trachomatis, therefore increases the risk of postoperative infection. The organism is found in approximately 7% of those applying for abortion and the risk of sustaining infection is 20%. Other risk factors are previous pelvic inflammatory disease, vaginal infection, first pregnancy and young age. Prophylactic antibiotics halve the incidence of infection, but by applying prophylaxis to risk groups only, the amount of prescriptions can be reduced. Prophylaxis need only be administered peroperatively, and tetracyclines, metronidazol, and penicillin/pivampicillin have been found to be effective. Women applying for abortion should be examined for C. trachomatis and positive cases treated no later than at the time of the abortion.
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PMID:[Preventive antibiotics in induced first-trimester abortion]. 146 1

General practitioners and obstetrician-gynecologists referred 301 women who were or= 56 days pregnant and asked for an abortion to the Royal Infirmary of Edinburgh in Scotland. Physicians administered 1 mg of gemeprost alone every 6 hours up to 3 mg to the 151 women and 200-600 mg mifepristone (RU-486) followed by 1 mg gemeprost 2 days later to 150 women. Women who received RU-486 and gemeprost were more likely to experience a complete abortion than those who received only gemeprost (98% vs. 87.4%; p = .0004). There were no significant differences in the efficacy of 200, 400, or 600 mg of RU-486 followed by gemeprost. Women who received gemeprost alone suffered more pain than those who received RU-486 and gemeprost so they were more likely to need analgesics (p = .0001). Women who received gemeprost alone experienced considerable more abdominal and pelvic pain as time passed (p .001 and .0002, respectively). In addition, women treated with gemeprost alone had a significantly lower median concentration of serum human chorionic gonadotropin on day 8 than those treated with RU-486 and gemeprost (median 1.78% VS. 3.57%; P .00101), even though more of them still were pregnant. On the other hand, both groups of women experienced the same duration of bleeding, interval from abortion induction to menstruation, and change in hemoglobin concentration between days 1 and 8. In the gemeprost alone group, most abortions occurred on day 1 and most abortions occurred on day 3 in the RU-486 and gemeprost group. Women treated with gemeprost alone were required to spend 1 night in the hospital while none of the women in the other group did. The RU-486 and gemeprost regimen had considerable advantages over the gemeprost-alone regimen for inducing an early medical abortion. Yet when RU-486 is not available or contraindicated, physicians can use gemeprost alone.
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PMID:Medical abortion in women of less than or equal to 56 days amenorrhoea: a comparison between gemeprost (a PGE1 analogue) alone and mifepristone and gemeprost. 152 4

Many studies in developed countries show a high frequency of psychological distress among women attending gynecology clinics. The aim of this study is to assess the prevalence of psychiatric morbidity among 239 women attending a gynecology clinic at Ilorin Maternity Hospital in Nigeria. The aim also was to test the validity of using the 30-item version of the General Health Questionnaire (GHQ-30) as a screening tool. Clinical diagnoses were recorded according to the International Classification of Diseases-Ninth Edition (ICD-9). Psychiatric morbidity was determined according to the method of Deshpande. Literate respondents used a self-administered GHQ-30 and illiterate respondents were interviewed with the GHQ-30. The psychiatric interview was conducted by a research psychiatrist. Patients were grouped into 1) patients with symptoms diagnoses according to ICD-9, 2) cases with subdiagnostic syndromes, and 3) patients without significant psychiatric symptoms. A basic demographic profile of patients is given. Obstetrics and gynecologic data reveal that 31.3% were nulliparous, 44.5% had between 1 and 4 children, and 24.5% had 5-8 children. 64.4% reported regular menses, 21.9% reported scanty menstrual flow, and 64.4% had a normal flow. 17/6% reported a history of induced abortion, and 43.4% reported previous spontaneous abortion. 23.6% had primary infertility and 28.3% had secondary infertility; infertility was the most common complaint. A score of 5 or higher on the GHQ-30 indicated a psychiatric case. 35/2% were found to suffer from definite psychiatric morbidity. An additional 6.4% had severe psychiatric symptoms. Of the psychiatric diagnoses, 34.1% were for neurotic depression, 24.4% for anxiety, 25.7% for adjustment reaction, 12.2% manic depressive psychosis (depressed type), 2.4% phobic state, and 1.2% schizophrenia. Psychiatric morbidity was found to be unrelated to age, marital status, religion, education, occupational group, or duration of marriage. Symptoms such as irregular menses, pelvic pain, ad having no children were factors significantly associated with psychiatric morbidity; this pattern is supported in the developed country literature. Policy should be directed to a preventive and biopsychosocial model of health care.
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PMID:Psychiatric morbidity in a gynaecology clinic in Nigeria. 161 88

Researchers enrolled 600 prostitutes from an AIDS control and prevention program in a study to determine the prevalence of Chlamydia trachomatis in prostitutes and other sexually transmitted diseases (STDs). The prostitutes worked in the port city of Santos, Brazil where many people use intravenous (IV) drugs. Only 45 prostitutes met the study criterion of 5-100 sexual partners/day. Health practitioners took sera from each woman to test for HIV-1, HIV-2, hepatitis B surface antigen (HBsAg) and antibody (HBsAb), Treponema species (syphilis), and C. trachomatis. All the women tested positive for C. trachomatis. This high percentage may have been due to previous contact with the microbe and not necessarily due to an active infection. 42% had been exposed to Treponema. 20% were HBsAb seropositive and 9% HBsAg seropositive. 9% tested positive for HIV-1 and 2% for HIV-2. In another study in Campinas, Brazil, HIV-1 and seropositivity was 21.5% for prostitutes and transvestites. In addition, in a study in metropolitan Sao Paulo, HIV infection prevalence varied from 18-73% among 935 women and 22% among prostitutes. 58% of the prostitutes in Santos had had sexual intercourse with bisexuals or IV drug users. 44% had previously experienced an STD. 42% used IV drugs. 42% practiced both oral and vaginal sex. 36% practiced oral, vaginal, and anal sex. Only 22% limited themselves to oral sex. Since C. trachomatis can cause infertility, chronic pelvic pain, and spontaneous abortion and since every prostitute in the study had been exposed to it, health workers should institute regular STD screening for prostitutes.
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PMID:Seropositivity to Chlamydia trachomatis in prostitutes: relationship to other sexually transmitted diseases (STDs). 210 Oct 95

A comprehensive historic, demographic, and medical questionnaire was administered to 106 women referred to a multidisciplinary clinic for evaluation of idiopathic chronic pelvic pain and to 92 age-matched, pain-free control patients presenting for routine annual examination. Although racial distribution, mean gravidity and parity, and rates of elective abortion were similar in both groups of respondents, spontaneous abortion was reported significantly more frequently among women with pelvic pain. Patients in the study group were also more likely to be on active military duty, to have undergone previous nongynecologic surgery, and to have sought treatment for unrelated somatic complaints. Finally, although the mean ages at first intercourse were similar, women with idiopathic pelvic pain reported a higher total number of sexual partners and were significantly more likely to have experienced previous significant psychosexual trauma. These findings confirm that predisposing psychosocial variables are important in the pathogenesis of idiopathic pelvic pain and emphasize the significance of multidisciplinary evaluation and management.
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PMID:Demographic and historic variables in women with idiopathic chronic pelvic pain. 230 12

Prolonged intrauterine retention of fetal bone parts is a rare complication of induced abortion, spontaneous intrauterine fetal death, and missed abortion. Here, a case of long-term retention of fetal bone fragments in a 47-year-old Italian women who underwent elective abortion 8 years earlier is reported. The patient was admitted for acute pelvic pain with purulent vaginal discharge. She reported recurrent episodes of abdominal and pelvic pain, meteorism, dysuria, nausea and vomiting, headaches, and irregular cycles with dysmenorrhea and inter menstrual bleeding since the 1979 abortion. Initially, pelvic inflammatory disease was diagnosed and antiphlogistic drugs were prescribed. When symptoms persisted after 10 days of drug treatment, the patient underwent a laparotomy that revealed pyosalpinx with extensive pelvic adhesions. Total hysterectomy with bilateral adnexectomy was performed. The uterine cavity was found to be closely packed with fragments that were determined at stereomicroscopic examination to be pieces of fetal bone. Of particular concern is the potential of this complication to lead to secondary infertility. The retained bone fragments can function similarly to an IUD by producing an increase in the local insertion of prostaglandins and preventing blastocyst implantation. Moreover, the retained fragments are an ideal substrate for bacterial colonization, which can spread to the tubes and destroy the functional integrity of the reproductive apparatus. Retention of fetal bones should thus be considered as a possible etiologic factor in cases of infertility of women with a history of abortion.
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PMID:Prolonged retention of fetal bones: intrauterine device and extrauterine disease. 236 50

Endometriosis is one of the most common conditions encountered in gynecology and the field of infertility. The clinical presentation depends on the location and the extent of disease, but the severity of symptoms does not correlate directly with the extent of disease. Symptoms of genital endometriosis may be categorized as menstrual dysfunction, ovulatory dysfunction, and reproductive dysfunction. With menstrual dysfunction, the frequent clinical symptoms are cyclic pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is commonly found to be the cause in younger patients with pain and dysmenorrhea, particularly when the clinician is aware of the appearance of atypical lesions. Types of ovulatory dysfunction reported to be associated with endometriosis include anovulation, premenstrual spotting, luteal phase defects, and LUF syndrome. The data are not sufficient to determine the prevalence of endometriosis, luteal phase defects, and hyperprolactinemia. With LUF syndrome, there are data to support an association, but more data on the frequency of LUF in consecutive normal cycles compared to consecutive cycles in women with endometriosis would be beneficial. A higher rate of infertility is reported in couples with endometriosis. Two approaches are used to evaluate spontaneous abortions and endometriosis. In retrospective studies, the abortion rates are higher in couples with endometriosis; however, when the pregnancy outcomes in untreated couples are studied, there is less evidence to support the association of a higher spontaneous abortion rate. Formerly, the diagnosis of endometriosis depended on the appearance of typical lesions. With the recognition of early or atypical lesions the histologic confirmation of glands and stroma is assuming a more prominent role. Noninvasive techniques such as assays of endometrial antibodies or CA-125 have certain limitations in terms of producing false-positive results and lacking predictability in early stages of disease. Ultrasonography and MRI give additional and confirmatory information. Most noninvasive techniques are ancillary in diagnosis and management. It still needs to be determined whether their routine use will give enough added information to justify their cost. Currently, the diagnosis of endometriosis is best made by histologic evidence of glands and stroma.
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PMID:Clinical presentation and diagnosis of endometriosis. 266 21

139 women at risk pregnancy (due to unprotected sexual intercourse) participated in a multicenter assessment of the efficacy and tolerability of RU 486 prescribed as a late luteal contragestive agent. 24 women received 400 mg of RU 486 and the remaining 115 women received 600 mg on the day before the expected menses. 48 women (35%) were found to be pregnant (positive plasma beta-human chorionic gonadotropin) at the time of RU 486 intake. An ongoing pregnancy after RU 486 treatment was found in 9 cases (failure rate, 19%). Bleeding occurred in all but 6 women, 1 of whom was pregnant. The duration of bleeding was 4.6 + or - 2.9 days in pregnant women and 3.8 + or - 1.2 days in nonpregnant women. A posttreatment menstrual period occurred 31.8 + or - 6.2 days after the onset of RU 486-induced bleeding in pregnant women and 30.0 + or - 5.3 days afterwards in nonpregnant women. Few side effects were reported (asthenia, pelvic pain, headache, mailase, and dizziness), and none required specific measures. These results indicate that, when it is too late for postcoital contragestive methods and too early for vacuum aspiration abortion, RU 486 constitutes a technique with at least as much effectiveness as high-dose estrogen therapy and fewer side effects and disturbances in the menstrual cycle. However, since the success rate is only 80%, it is essential to schedule a posttreatment visit to identify women with ongoing pregnancies or incomplete uterine evacuation.
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PMID:Contragestion with late luteal administration of RU 486 (Mifepristone). 304 66


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