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

Coincident with the epidemic of sexually transmitted diseases, the incidence of pelvic inflammatory disease has risen sharply in recent years. Pelvic inflammatory disease is a major direct cause of infertility; in addition, it leads to ectopic pregnancies and chronic inflammatory residua requiring surgical intervention. This threat to the future fertility of women is rendered more serious by the difficulty of making a correct diagnosis and the likelihood that faulty diagnosis will result in inadequate treatment. Pelvic inflammatory disease is caused not only by Neisseria gonorrhoeae but also by Chlamydia trachomatis, genital tract mycoplasmas, and mixed bacteria from the endogenous vaginal and cervical flora, especially anaerobes. Diagnostic criteria include (1) lower abdominal and pelvic pain, (2) lower abdominal tenderness, (3) elevation of erythrocyte sedimentation rate, (4) adnexal inflammatory mass, and (5) presence of leukocytes and bacteria in the peritoneal fluid. Early diagnosis and prompt treatment appear to be crucial in preventing infertility. No studies have evaluated prospectively the relative advantages of inpatient vs. outpatient management of acute pelvic inflammatory disease. The recommendations of the Centers for Disease Control (CDC; Atlanta, Ga.) for outpatient treatment and the results of a multi-hospital collaborative study using the CDC regimens are discussed. Criteria for hospitalization and parenteral antibiotic therapy are presented.
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PMID:Pelvic inflammatory disease: etiology, diagnosis, and treatment. 733 Jul 55

The knowledge needed to formulate proper indications for hysterectomy include a thorough understanding of the physiology and pathology of the female reproductive organs, the clinical manifestations of pelvic disease, and normal and abnormal psycho/social/sexual development. This basic and thorough knowledge and understanding is the absolute foundation on which to base the practice of gynecologic surgery. After the right operation has been selected for operation, the right operation must be selected for the patient. The successful practice of gynecologic surgery also requires proper preparation of the patient for the operation, proper performance of the operation, and proper postoperative care. A competent gynecologist who has followed a patient for several years, has kept careful records of findings and treatment, and has the patient's full confidence is most likely able to make the most accurate judgment about the necessity for hysterectomy. Yet, in most circumstances a 2nd opinion should still be sought. Apprpriate indications for hysterectomy include benign uterine disease and/or symptoms -- dysfunctional uterine bleeding; uterine pain, bleeding, and enlargement; uterine descensus and prolaspe; uterine leiomyomas; septic abortions; and obstetric catastrophs. Other indications include benign diseases of the tubes and ovaries in which the uterus is not primarily involved -- pelvic inflammatory disease, pelvic endometriosis, and ectopic pregnancy -- and neoplastic disease, namely, cervical intraepithelial carcinoma (carcinoma in situ), early invasive cervical cancer, endometrial adenocarcinoma and sarcoma, trophoblastic disease, ovarian and fallopian tube neoplasms, and malignant disease of other adjacent organs. Miscellaneous and usual indications for hysterectomy include cervical problems such as servical stenosis with recurring pyometra following unsuccessful attempts to keep the cervix open, chronic pelvic pain, pelvic congestion syndrome, and surgical sterilization. A partial list of inappropriate indications for hysterectomy includes prophylaxis against uterine cancer, contraception in a gynecologically normal patient, management of the menopause, leukorrhea and chronic cervictis, primary dysmenorrhea and premenstrual tension, mild urinary incontinence, postmenopausal bleeding, abnormal vaginal/cervical cytology, and cervical dysplasia.
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PMID:Indications of hysterectomy. 733 47

Twenty patients have undergone presacral neurectomy at Yale-New Haven hospital over the past 7 years. The patients were separated into three subdivisions according to abnormal findings at the time of surgery: group I, endometriosis; group II, pelvic inflammatory disease (PID); and group III, those patients with neither endometriosis nor pelvic inflammatory disease but with pelvic pain and infertility. At the time of surgery, an attempt was made to correct and repair coexistent pelvic abnormalities. The groups were evaluated for relief of pain and subsequent viable intrauterine pregnancy. A control group of infertility patients complaining of pain who underwent infertility laparotomy without presacral neurectomy was used for comparison. Presacral neurectomy has traditionally been performed for pain associated with endometriosis and has resulted in subsequent pain relief and pregnancy rates of 30% to 60%. Pregnancy rates of 46% to 47% were found in the PID group, the endometriosis group, and the control group. In addition, 75% of the patients with either PID or endometriosis had significant relief of pain following presacral neurectomy as compared with only 26% of the control group undergoing only infertility laparotomy. It is concluded from these findings that presacral neurectomy plus reconstructive pelvic surgery is more effective than infertility laparotomy alone for the treatment of pelvic pain but that presacral neurectomy does not increase the subsequent incidence of pregnancy.
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PMID:Presacral neurectomy for pelvic pain in infertility. 745 74

This study determined, through medical record evaluation, whether tubal sterilizations entail a significant risk of later complications leading to rehospiralization. The records of 514 consecutively sterilized women (cases) were reviewed; 514 consecutive women of similar parity who delivered at the same institution during the same year were selected as controls. 113 cases (22%) and 157 controls (31%) were readmitted during the follow-up period. Of the readmitted women, almost one-third of the cases (32%) required readmissions for gynecologic reasons compared with 14% of controls. 68% of cases were readmitted for medical-surgical reasons compared with 21% of controls. Both of these readmission statistics were significantly different at the P .01 level. Age was a factor in readmission data, with 30-39 year olds being readmitted for other than obstetric reasons more often than 20-29 year olds (P .01). Only 19% of immediate postpartum sterilizations were readmitted compared with 30% of interval sterilizations (P .02). The Pomeroy technique was used most frequently (86%), and 31% of Pomeroy interval vs. 18% of Pomeroy postpartum were readmitted. The most common reasons for readmission were: 1) menstrual irregularities, 2) pelvic pain, 3) leiomyoma, 4) acute pelvic inflammatory disease, 5) cervical intraepithelial neoplasia, 6) cardiovasular condition, and 7) breast surgery.
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PMID:Tubal sterilization and later hospitalizations. 745 37

Between April 1988 and June 1991, health workers in Nigeria followed 300 women aged 20-40 who had had a copper releasing IUD inserted during menstruation at the family planning clinic of the University College Hospital in Ibadan. The double blind clinical trial compared the effectiveness and side effects of three copper releasing IUDs: Copper T380A, Multiload 375, and Multiload 250. 75.7% had used no contraception before admission to the study. Pelvic inflammatory disease (PID) occurred more often in the MLCU 250 group than the other two groups. Only two women were hospitalized for PID. These two women used the TCU 380A or MLCU 250. Many IUD users experienced abdominal pain during menstruation and TCU 380A users had the highest rate (27% vs. 21-24%). Heavy bleeding during menstruation was more common in TCU 380A and MLCU 375 users (5% and 4%, respectively, vs. 2%). Pelvic pain/cramps were present in 1-3% of women, but did not contribute to removal. The only case of uterine perforation was in a user of the TCU 380A. None of the MLCU 375 users experienced IUD expulsion, while two TCU 380A users experienced total expulsion and two and one MLCU 250 users experienced total and partial expulsion, respectively. PID was related to IUD removal at 6 months (3.1% vs. 0; p 0.05). The pregnancy rate at 6 months was 1.1% for the TCU 380A group and 0 for the other groups. At 12 months, it was 1.1% for the TCU 380A group and the MLCU 375 group and 0 for MLCU 250. The net 6-month IUD cumulative termination rate was highest in the TCU 380A group (11.1% vs. 3-7%; p 0.05). These differences were no longer significant at 12 months. The net 6- and 12-month IUD continuation rate was 97% and 92% for MLCU 375 compared to 88.9% for TCU 380A and 93% for MLCU 250 and 85.8% for TCU 380A and 87% for MLCU 250, respectively. These findings suggest that these three IUD devices could be used in the hospital's family planning clinic.
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PMID:Performances of copper T 380A and multiload copper 375/250 intrauterine contraceptive devices in a comparative clinical trial. 749 2

The anamnesis, the preoperative diagnostics, the laparoscopic findings, and the therapeutic management are reported of 303 patients who underwent laparoscopy because of chronic pelvic pain during the years of 1989 and 1993. The most common laparoscopic diagnosis were adhesions of the bowel and omentum (34.7%), adhesions of the genital organs (24.1%) and endometriosis (19.8%). In 31.4% there were normal pelvic findings. In patients with a history of surgical or other gynecological procedures we found significantly more adhesions as compared to nontreated controls; the adhesions were predominantly confined to the bowel and rather than the gynecologic pelvis. PID-Patients had significantly more genital adhesions. The high frequency of surgical laparoscopies and therapeutic recommendations following a diagnostic laparoscopy emphasize the importance of a laparoscopic investigation in patients with chronic pelvic pain.
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PMID:[The value of laparoscopy in diagnosis and therapy in patients with chronic pelvic pain]. 764 58

Five hundred and nine Laparoscopic examinations performed between 1987-91, (147 procedures for evaluation of gynaecologic pelvic pain and 313 for infertility) revealed ectopic pregnancy (27%), twisted ovarian cyst (18%) and acute pelvic inflammatory disease (14%) in cases of acute gynaecologic pain, and endometriosis (17%) and chronic pelvic inflammatory disease (16%) in chronic pelvic pain. Adhesions (20%), tubal block (15%), endometriosis (9%) and polycystic ovary (7%) were common findings in cases of infertility. These data support the usefulness of this minimally invasive procedure in accurate diagnosis of gynaecological disorders and provides insight into the spectra of diseases seen in Pakistani women with pelvic pain and infertility.
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PMID:Laparoscopic appraisal of infertility and pelvic pain in Pakistani women: a 5 years audit. 804 Sep 92

Researchers examined results of cervico-vaginal smears of 350 women aged 23-45 years fitted with IUDs at various family planning clinics in Kuala Lumpur, Malaysia, to examine abnormalities in their genital tract. All the women had undergone preinsertion cervico-vaginal smears. They used the IUD for 1-8 years. Around 66% exhibited symptoms after IUD insertion. 40% had vaginal discharge, especially mucous. 3% had pelvic pain and intermittent low grade fever, suggesting pelvic inflammatory disease. 80% had an increase in the number of leukocytes in their blood. 42% had an increase in the number of histiocytes with multinucleate giant forms. The following microorganisms were present: Gardnerella vaginalis (42%), Trichomonas vaginalis (32%), Candida (28%), Actinomyces-like organisms (2%), and non-pathogenic Amoeba (0.6%). Both endocervical and squamous columnar cells exhibited morphological atypias (inflammatory, degenerative, or reparative changes). 70% of atypias were benign and varied from mild to severe. 14 women (4%) had cervical intra-epithelial neoplasia (CIN). 3% of the women had atypical single cells. The IUDs were removed from all of these women. 6 months after IUD removal, the cervixes with mild dysplasia had reverted to normal. Two women with severe dysplasia underwent cervical biopsy, which revealed a CIN III lesion. 28% of smears had abnormal or irritated glandular epithelial endocervical and endometrial cells with hyperchromatic nuclei, an increased nucleo-cytoplasmic ratio, and bubble-gum vacuolation of the cytoplasm. 31% of the women had normal or inflamed out-of-phase (beyond day 11 of the menstrual cycle) endometrial cells. 80% of these 109 women had menorrhagia or intermenstrual bleeding. The researchers recommend that serious epithelial atypias be followed up and the IUD be removed. IUD removal allows clinicians to determine whether atypias will regress in the absence of an IUD or are truly neoplastic.
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PMID:Cytopathologic changes associated with intrauterine contraceptive devices. A review of cervico-vaginal smears in 350 women. 805 95

In Winston-Salem, North Carolina, researchers compared prospective data on 64 consecutive women (18-70 years old, only 2 of whom were postmenopausal) who experienced laparoscopic adnexectomy between January, 1991, and March, 1993, with retrospective data on 26 consecutive women (21-44 years old) who experienced adnexectomy by laparotomy between January, 1989, and December, 1991. The indication for adnexectomy for most women was pelvic pain (91% for laparoscopy patients and 92% for laparotomy patients). The reasons for the pelvic pain included chronic pelvic inflammatory disease, recurrent ovarian cyst, endometrioma, cyclic ovarian pain, and periovarian adhesions. Among women with no pelvic pain, 7 women had a chronic adnexal cyst, and 1 woman had an ovary secreting an androgen. The median operative time for laparoscopy was significantly shorter than for laparotomy (88 vs. 107 minutes; p = .04). Even though the estimated blood loss was significantly less among laparoscopy patients than laparotomy patients (72 vs. 222 ml; p = .01), the change in hematocrit in both groups was not significant (3.9 vs. 5.2), and no one needed a blood transfusion. Women in the laparoscopy group were in the hospital for a significantly shorter period (1 vs. 3 days; p = .0001) and recovered more rapidly (1 vs. 4 weeks; p = .001) than did those in the laparotomy group. The total cost was lower for laparoscopic adnexectomy than for adnexectomy by laparotomy ($4573 vs. $6044; p = .02). Women in both groups noted improvement in pelvic pain. Just 1 woman from each group had a major complication. These findings suggest that experienced laparoscopic surgeons can quickly, safely, and effectively perform adnexectomy using laparoscopy.
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PMID:Laparoscopic adnexectomy: a comparison with laparotomy. 805 16

The aim of this study was to investigate the association between on the one hand pelvic inflammatory disease (PID), induced abortion, postabortal complications and age and on the other the rate of spontaneous abortion. The influences of PID, induced and spontaneous abortion, postabortal complications, age and parity on the rates of dyspareunia, dysmenorrhea and chronic pelvic pain were also investigated. Questionnaires were given to all women referred for delivery and induced first-trimester abortion to the Department of Obstetrics and Gynaecology at Gentofte hospital during the period January-May 1988. Altogether 1229 women answered the questionnaire, 868 were referred for delivery and 361 for induced abortion. In 839 women without previous induced abortion, a history of PID was associated with an increased risk of spontaneous abortion (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.03-2.33); women above the age of 33 had a lower risk of spontaneous abortion (OR 0.53, 95% CI 0.30-0.96). In 382 women with previous induced abortion, the influence of age on the rate of spontaneous abortion was continuous so that an increase of one year of age reduced the risk of spontaneous abortion by 0.91 (95% CI 0.85-0.96). Women with any previous PID when compared to those without, more often had dyspareunia (14 versus 3%, OR 3.87, 95% CI 2.35-6.37) and chronic pelvic pain (six versus 0.4%, OR 13.07, 95% CI 10.09-16.04). Age was inversely associated with the incidence of dysmenorrhea (OR 0.94, 95% CI 0.91-0.97). We conclude that PID is associated with spontaneous abortion, whereas age correlates inversely with the rate of spontaneous abortion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Factors influencing incidence of spontaneous abortion, dyspareunia, dysmenorrhea and chronic pelvic pain]. 799 52


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