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

Induced abortion is one of the most frequent surgical procedures in the UK. Even though it is considered safe, it sometimes has complications and long-term sequelae. Pelvic inflammatory disease (PID) is the most prevalent complication and can lead to chronic pelvic pain, pain during intercourse, infertility, and a higher risk of ectopic pregnancy. Chlamydia trachomatis is perhaps the leading etiologic agent for PID among women who have undergone induced abortion and who develop PID. Gonorrhea is another major etiologic agent for PID. Strategies used to try to reduce pelvic infection revolve around administration of antibiotic prophylaxis based on demographic features and on the presence of certain organisms in the genital tract that may increase their risk (e.g., C. trachomatis and Neisseria gonorrhoeae) and universal antibiotic prophylaxis for all women undergoing abortion. Most of the literature suggests that antibiotic prophylaxis does provide some protection against PID but does not clearly indicate who should be screened and for which pathogens and who should be treated and with which antibiotics. Demographic features useful for identifying who should receive antibiotic prophylaxis are: a history of PID, single status, nulliparity, and youth (especially reliable for chlamydial infection). Screening for bacterial vaginosis involves diagnosis based on 3 of 4 criteria: characteristic vaginal discharge, positive amine test, raised vaginal pH, and the presence of clue cells on microscopy of wet or stained preparations of vaginal discharge. Since C. trachomatis is the most important pathogen, drugs sensitive to it should be administered: tetracyclines and erythromycin. Screening women seeking abortion for sexually transmitted diseases (STDs) provides an opportunity to educate them about STDs and treatment compliance and to contact their partners for investigation, treatment, and contact-tracing to reduce the STD-infected pool in the community.
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PMID:Preventing pelvic infection after abortion. 854 9

Pelvic inflammatory disease (PID) results from an ascending polymicrobial infection of unclear pathogenesis. One in 10 women in the United States has PID during her reproductive years. Medical costs of managing the disease and its sequelae are over $5 billion per year. One out of four women with PID has serious sequelae, including infertility, ectopic pregnancy or chronic pelvic pain. Patients with PID present with a spectrum of clinical symptoms and signs, none of which conclusively makes the diagnosis. The diagnosis of PID relies on a high index of suspicion, coupled with empiric therapeutic intervention and careful follow-up. Revised guidelines from the Centers for Disease Control and Prevention include recommendations for the use of broad-spectrum antibiotics, which are initiated before culture results are obtained. Indications for hospitalization are more liberal now than under the previous CDC recommendations. Prompt recognition, patient compliance with recommended therapy and treatment of the sexual partner decrease the risk of sequelae. Family physicians can make significant contributions to the health care of women through skillful management of PID.
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PMID:Pelvic inflammatory disease: a contemporary approach. 862 62

Pelvic inflammatory disease (PID) is a common and poorly managed condition. Untreated or inadequately treated, it leads to tubal infertility, ectopic pregnancy and chronic pelvic pain. Diagnostic difficulties are compounded by the wide variety of clinical presentations and the insensitivity and poor specificity of laboratory tests. Better recognition of mild and atypical disease needs a high index of suspicion whenever young, sexually active women present with gynaecological symptoms. Laparoscopy supplemented by microbiological tests and fimbrial minibiopsy should be regarded as the diagnostic 'gold standard' for research studies; new studies are required to identify techniques which might reduce under- and over-diagnosis. Early treatment reduces the risk of an adverse effect on fertility. Any therapeutic regimen selected should be effective against the common aetiological agents Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas and aerobic and anaerobic bacteria. Since at least 60% of cases of PID can be attributed to infection with a sexually transmitted organism, partner notification forms an essential part of management.
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PMID:Clinical aspects of pelvic inflammatory disease. 943 68

Pelvic inflammatory disease (PID), an infection of the female genital tract, presents a number of difficult challenges in diagnosis and management. Adolescents in particular require aggressive care of PID to prevent the long-term sequelae of chronic pelvic pain and infertility. This article reviews the etiology, microbiology, diagnosis, and management of PID, with an emphasis on treating adolescents with PID.
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PMID:Pelvic inflammatory disease: the importance of aggressive treatment in adolescents. 967 92

Pelvic inflammatory disease (PID) is a generic term relating to a broad range of conditions. The term is used to describe infections of the fallopian tubes, uterus, ovaries, or peritoneum. PID is a potentially life-threatening condition in any woman, but HIV-positive women are at serious risk of severe complications or death. PID is caused when infection-producing organisms spread upwards from the vagina through the cervix to the upper reproductive organs. Untreated sexually transmitted diseases are a leading cause of PID. Consequences include chronic pelvic pain, abdominal abscesses, inflammation of the covering of the liver, sepsis, and death. Sterility may also result from PID. PID is generally treated with a combination of antibiotics, and it is crucial to treat other concurrent infections as well. Early treatment of PID in HIV-positive women is essential.
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PMID:Pelvic inflammatory disease. 1136 14

Pelvic inflammatory disease affects approximately 1 million women per year in the United States alone and has a variety of causative organisms. Because the diagnosis of PID is based on clinical judgment, health care providers need to be guided by the CDC recommendations for diagnosing and treating PID. Because presenting symptoms are often vague, the health care provider should assess female patients for risky behaviors that may lead to PID and should use screening data when making clinical judgments and differential diagnoses. Whenever possible, female patients with PID should be treated as outpatients. If diagnosis and treatment are not performed in a timely manner, PID may cause sepsis, septic shock, and even death. Even if they survive, as many as 15% to 20% of these women experience long-term sequelae of PID, such as ectopic pregnancy, tubo-ovarian abscess, infertility, dyspareunia, and chronic pelvic pain. The best treatments for PID are interventions that lead to prevention and early detection. The critical care nurse has an important role in recognizing the variables that may lead to PID-related sepsis and in encouraging health-seeking and health-maintenance behaviors among women with these diagnoses.
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PMID:Pelvic inflammatory disease and sepsis. 1259 41

Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more accurate diagnosis of this entity since it enables differentiation between acute and chronic stages based on analysis of the vascular resistance. Hemorrhagic ovarian cysts may be presented by variety of ultrasound findings since intracystic echoes depend upon the quality and quantity of the blood clots. Color Doppler investigation demonstrates moderate to low vascular resistance typical of luteal flow. Leiomyomas undergoing degenerative changes are another cause of acute pelvic pain commonly present in patients of reproductive age. Color flow detects regularly separated vessels at the periphery of the leiomyoma, which exhibit moderate vascular resistance. Although the classic symptom of endometriosis is chronic pelvic pain, in some patients acute pelvic pain does occur. Most of these patients demonstrate an endometrioma or "chocolate" cyst containing diffuse carpet-like echoes. Sometimes, solid components may indicate even ovarian malignancy, but if color Doppler ultrasound is applied it is less likely to obtain false positive results. One should be aware that pericystic and/or hillar type of ovarian endometrioma vascularization facilitate correct recognition of this entity. Pelvic congestion syndrome is another condition that can cause an attack of acute pelvic pain. It is usually consequence of dilatation of venous plexuses, arteries or both systems. By switching color Doppler gynecologist can differentiate pelvic congestion syndrome from multilocular cysts, pelvic inflammatory disease or adenomyosis. Ovarian vein thrombosis is a potentially fatal disorder occurring most often in the early postpartal period. Hypercoagulability, infection and stasis are main etiologic factors, and transvaginal color Doppler ultrasound is an excellent diagnostic tool to diagnose it. Acute pelvic pain may occur even in normal intrauterine pregnancy. This may be explained by hormonal changes, rapid growth of the uterus and increased blood flow. Ultrasound is mandatory for distinguishing normal intrauterine pregnancy from threatened or spontaneous abortion, ectopic pregnancy and other complications that may occur in patients with positive pregnancy test. Incomplete abortion is visualized as thickened and irregular endometrial echo with certain amount of intracavitary fluid. If applied, color Doppler ultrasound reveals low vascular resistance signals in richly perfused intracavitary area. Transvaginal sonography has high sensitivity and specificity in visualization of uterine and adnexal signs of ectopic pregnancy. Color Doppler examination may aid in detection of the peritrophoblastic flow. Furthermore, it facilitates detection of ectopic living embryo, tubal ring or unspecific adnexal tumor. Corpus luteum cysts and leiomyomas are another cause of pelvic pain during pregnancy, which can be correctly diagnosed by ultrasound. Detection of uterine dehiscence and rupture in patients with history of prior surgical intervention on uterine wall relies exclusively on correct ultrasound diagnosis. In patients with placental abruption sonographer detects hypoechoic complex representing either retroplacental hematoma, subchorionic hematoma or subamniotic hemorrhage. In closing, ultrasound has already become important and easily available tool which can efficiently recognize patients with possibly threatening conditions of different origins.
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PMID:[Ultrasonography in acute pelvic pain]. 1276 97

Pelvic inflammatory disease (PID) is highly prevalent among sexually active adolescent females. The major organisms are N gonorrhoeae and C trachomatis. Diagnosis is based on historical information and clinical findings. Early diagnosis and treatment effectively reduce the incidence of complications associated with PID. Highly effective treatment regimens are available and main antimicrobials used include quinolones, cephalosporins, metronidazole, doxycycline, and azithromycin. Delay or inadequate treatment is associated with long term sequelae including tubal infertility and chronic pelvic pain. Prevention efforts should be directed towards routine screening and treatment for sexually transmissible infections, public education and provision of resources for treatment and follow-up.
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PMID:Management of pelvic inflammatory disease in adolescents. 1544 93

Pelvic inflammatory disease (PID) is an important health problem. Delay in diagnosis and effective treatment contributes to inflammatory sequelae with risk of future fertility problems and chronic pelvic pain. Treatment regimens must provide empiric, broad-spectrum coverage of likely pathogens but also take into account patient's risk profile. In this article we report the case of a young woman affected by a rare genital malformation who required the creation of a neovagina made of abdominal skin. Years later, the patient presented with symptoms that support the diagnosis of PID. There was no clinical analytical response to classical parenteral antimicrobial regimen, even after surgical intervention for tubal abscess. Peptostreptococci isolated in abdominal cavity culture showed an infrequent clindamycin resistance, so we started monotherapy treatment with ertapenem, with excellent results. In conclusion, more clinical trials are needed to discover the pathogens usually involved in PID in our setting and their antibiotic resistance to re-evaluate standard antimicrobial regimens and perhaps recommend new agents, such as ertapenem.
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PMID:[Severe pelvic inflammatory disease. Response to ertapenem]. 1644 94

Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. The spectrum of disease ranges from subclinical, asymptomatic infection to severe, life-threatening illness; sequelae include chronic pelvic pain, ectopic pregnancy, and infertility. PID is diagnosed clinically, with laboratory and imaging studies reserved for patients who have an uncertain diagnosis, are severely ill, or do not respond to initial therapy. The Centers for Disease Control and Prevention diagnostic criteria include uterine, adnexal, or cervical motion tenderness with no other obvious cause in women at risk of PID. Empiric treatment should be initiated promptly and must cover Chlamydia trachomatis and Neisseria gonorrhoeae; the possibility of fluoroquinolone-resistant N. gonorrhoeae also should be considered. Hospitalization for initial parenteral therapy is necessary for patients with tubo-ovarian abscess and for those who are pregnant, severely ill, unable to follow a prescribed treatment plan, or unable to tolerate oral antibiotics. Patients also should be hospitalized if a surgical emergency cannot be excluded or if no clinical improvement occurs after three days. Routine screening for asymptomatic chlamydial infection can help prevent PID and its sequelae.
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PMID:The challenge of pelvic inflammatory disease. 1652 95


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