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Query: UMLS:C0242172 (pelvic inflammatory disease)
 3,755 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the 1980s, a study showed an association between IUD use and pelvic inflammatory disease (PID) and subsequent infertility. About the same time, 2 major manufacturers of IUDs stopped making IUDs. These 2 events caused a decline in IUD use worldwide. In Singapore, however, the decline began in the 1960s when the Family Planning Board withdrew the IUD from its 5 year plan. After that, researchers in Singapore 1st conducted randomized prospective trials of most new IUDs. For example in the late 1980s, they began a prospective trial of the MLCu380 with a complicated insertion system. Multicenter trails have demonstrated that at least 5 of the newest copper IUDs have a failure rate of 2/100 woman years and 1/100 for 3 other new copper IUDs. Some manufacturers have increased the area of exposed copper from 200-250mm to 375-380mm to increase efficacy, but a prospective trial in Singapore did not show an increase. A large multicenter trial has shown that the levonorgestrel releasing IUD (LNg20) has a very low failure rate (.12/100) and reduces menstrual loss, unlike the copper IUDs. Due to legal concerns over the medical grade plastic, however, the manufacturer stopped distributing it in the late 1980s. WHO hoped to identify a manufacturer for the plastic so further trials could begin around 1991. In the late 1980s, WHO studied the silver cored copper wire IUD used to prevent fragmentation. Since IUDs change the endometrium which suppresses intrauterine pregnancies but not extrauterine pregnancies, the risk of an ectopic pregnancy is 10 times that of a nonuser. The risk is lower in copper IUDs suggesting that copper ions reduce the chance of fertilization in the Fallopian tubes. The risk of PID in IUD users ranges from 1.5-2.6. The majority of IUD associated PID occurs within 4 months following insertion and in nulliparous patients with several sexual partners.
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PMID:Current concepts on the use of IUDs. 281 45

Hysterosalpingography (HSG) with lipiodol ultra fluid was performed in 294 infertile women with a normal ovulatory temperature curve and at least two years of infertility and a partner with normal sperm. In 21 per cent, pregnancy occurred within 6 months after the examination, and about one third of the women with a normal finding or with intraperitoneal adhesions at HSG conceived. The pregnancy rate was especially high in the first two cycles after HSG. The spontaneous pregnancy rate was 8 per cent, and the difference between this and the total number of pregnancies must be attributed to a therapeutic effect of the procedure. Previous pelvic inflammatory disease was present in 40 per cent of those who did not become pregnant, while only 11 per cent of those who conceived had previous inflammation. Of the women without previous gynecologic disease 30 per cent conceived.
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PMID:Therapeutic value of hysterosalpingography with lipiodol ultra fluid. 282 Apr 54

The 1985 Communicable Disease Surveillance Center figures for sexually transmitted diseases document over 14,000 confirmed cases of genital chlamydial infection in women. Yet, this figure seriously underestimates the size of the problem as many chlamydial infections are silent. The mainstay of diagnosis until recently has been isolation of C. trachomatis in cell culture, which is time consuming, technically demanding, expensive, and available in only a few centers. A firm diagnosis of chlamydial infection cannot be based on serology alone. Antibodies can be detected in 78-100% of womn with C. trachomatis in the cervix, but in those who are culture negative 31-87% also will have antibodies. More support is given to the diagnosis by demonstration of a rising titre of IgG antibody or by detection of IgM, but because of the late presentation of most women with chlamydia this is seldom possible. Newer tests include direct immunofluorescence statining of genital secretions which is rapid and simple. Results of this method compare favorably with those of cell culture, but screening large numbers of smears is expensive and tedious. Enzyme-linked immunosorbent assays also give good results. C trachomatis is a well known cause of cervicitis and salpingitis and is consequently a major factor in infertility. The frequency of chlamydial infection is influenced by sexual activity and promiscuity, but the effect of contraceptive choice is more difficult to determine. An IUD can provide a nidus for many infections, but the role of oral contraceptives (OCs) is more controversial. Instrumentation of the endocervical canal provides a route for introduction of infection, which is therefore a frequent and important complication of induced abortion. Westergaard et al. in a study of women having 1st trimester abortions found that 10% had symptomless cervical chlamydia; postabortal pelvic inflammatory disease developed in 28% of these patients by comparison with 10% in culture-negative women. Other workers have found similar results. The role of chlamydia as a cause of morbidity in pregnancy is unclear. Complications for the newborn are better established. It has been estimated that between 2-37% of mothers will have a chlamydia infection in pregancy. If 33-50% of newborns at risk get conjunctivitis, and 10-20% get pneumonitis, this gives some indication of the extent of the problem. Several studies have suggested an association between cervical chlamydial infection, anti-chlamydial antibodies, and cervical dysplasia. Emphasis on early diagnosis and treatment is of paramount importance to reduce the prevalence of chlamydial infection and its complications; without this rates of ectopic pregnancy and infertility are bound to increase.
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PMID:Chlamydia in women: a case for more action? 287 Mar 60

Laparoscopy has become the most important investigative tool for the evaluation of tubal disease in developed countries of the world. In this report of 218 diagnostic laparoscopies performed on infertile Nigerian women, bilateral tubal occlusion was found in 35.3% and unilateral occlusion in 9.6%. Pelvic adhesions were present in 55.0% out of which 25.2% and 21.1% were moderate or severe, respectively. Endometriosis and uterine fibroids were present in 1.4% and 26.6% of patients, respectively. Bilateral tubal occlusion has been shown to be the commonest cause of female infertility in Africa. Some of the worst results of tubal surgery come from Africa where, ironically, the prevalence of tubal disease is highest. Patients with gross tubal disease and/or widespread pelvic adhesions should be listed for in-vitro fertilization programs which are currently providing reasonable satisfactory results in the developed countries of the world. Health programs in the African continent must incorporate preventive measures for pelvic inflammatory disease complicating a variety of sexually transmitted diseases and pregnancy termination in order to reduce the presently high prevalence of tubal infertility.
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PMID:Laparoscopic evaluation of the tuboperitoneal factor in infertile Nigerian women. 288 45

A study of uterine fibromyomata at the Ahmadu Bello University Teaching Hospital, Zaria indicates that the condition occurs in 7.8% of new gynecology cases. Infertility 87.2%, menstrual disturbance 70.4%, in association with chronic pelvic inflammatory disease 43.4%, anemia 25.0% and hypertension 25.5% were the commonest presentations. Total abdominal hysterectomy was commonly performed due to the high rate of chronic pelvic inflammatory disease. Post-operative morbidity was due to pyrexia in 28.6%, hemorrhage in 7.1% and wound infection in 6.6% of the series.
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PMID:Uterine fibromyomata: presentation and management in northern Nigeria. 288 37

Determinants of infertility were studied in 340 women in Eastern Gabon, an area situated in the "infertility belt" of Central Africa. Fallopian tube occlusion was diagnosed in 82.8% of cases, showing the importance of infection-related causes. Women with tubal occlusion did not differ significantly from women with normal tubes in obstetrical history or prevalence of Neisseria gonorrhea or Chlamydia trachomatis on endocervical culture. Antecedents of pelvic inflammatory disease or a pelvic mass were significantly more common in the group with tubal occlusion. This group also had a significantly higher prevalence of serum chlamydial antibodies at a titer of 1/64 or higher. Hormonal factors were found in 31.7% of women, a cervical factor in 29.0% and mechanical factors in 5.6%. No diagnosis could be made in 12.2% of cases. During the investigation, 4.4% of women became pregnant. The predominance of infectious related causes of infertility makes it imperative to focus resources on prevention programs of upper genital tract infections in women. The study sample is from a small semi-urban center of 25,000 inhabitants and consisted of all women consulting for infertility at the gynecology department of the Franceville hospital from January 1983 until December 1984.
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PMID:Infertility in Central Africa: infection is the cause. 290 Jan 73

The serology of various infections often caused by Chlamydia trachomatis including complications such as pelvic inflammatory disease (PID) and infertility was investigated comprehensively among diverse patient groups in a developing country using initially an indirect immunofluorescent antibody test (IFA). Any positives detected were further examined by a micro-immunofluorescence (MIF) method for the presence of type specific anti-chlamydial IgG/IgM antibodies. Conventional cell culture was carried out concurrently to compare culture results with serologic results. Among 416 patients (107 males and 309 females) C. trachomatis D-K antibodies to IgG were identified in 87 (20.9%) and to type specific IgM were identified in 11(2.6%) patients. Cell culture identified C. trachomatis in 60 patients (14.4%). C. trachomatis IgG antibodies were detectable in 6.4% of chlamydia culture negative patients.
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PMID:Serologic diagnosis of Chlamydia trachomatis infections. 290 1

A dramatic increase in the incidence of pelvic inflammatory disease in recent years has led to a parallel increase in consequent infertility. The economic and psychologic costs of infection and infertility are severe and preventable. The author reviews and outlines current diagnostic and therapeutic recommendations that are now being used to prevent infectious morbidity. A brief review of the indications, techniques, and prospects for surgical correction of tubal disease and pelvic adhesions is also presented.
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PMID:Pelvic inflammatory disease. 293 23

This state-of-the-art review focuses on the epidemiology, etiology, diagnosis, and treatment of pelvic inflammatory disease (PID). 5-20% of hospital admissions for gynecologic problems are secondary to PID; the condition itself is associated with health care costs of about $1.25 billion each year in the US. Special consideration is given in this article to in vivo and in vitro studies of antimicrobial therapy, including both established regimens and expanded spectrum beta-lactam antibiotics. Early treatment of PID can reduce the effects of the infection on the fallopian tubes; however, microbe-related inflammation and tubal necrosis can precede the manifestation of symptoms, especially in cases where Chlamydia is the infecting agent. The 2nd-generation cephalosporins seem to offer advantages in the treatment of PID because of an expanded spectrum that includes many of the major pathogens. In vitro tests have demonstrated considerable activity against penicillinase-producing strains of N gonorrhoeae resistant to both penicillin and 1st-generation cephalosporins. Cefoxitin is currently considered the most attractive such cephalosporin and has shown cure rates of 95-100% in the treatment of uncomplicated gonorrhea. Also reviewed in this article are adjunctive methods of treatment, including treatment of sexual contacts, removal of IUDs, use of alternate methods of contraception associated with a reduced risk of disease and surgery. Oral contraceptives are the logical alternative when a switch in contraception is indicated given the lower risk of PID incidence and severity, infertility, and ectopic pregnancy in pill users. There remains a need for well-designed, prospective, comparative studies of new treatment regimens.
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PMID:Pelvic inflammatory disease: a review with emphasis on antimicrobial therapy. 293 30

The hysterosalpingogram has been extensively used in infertility investigations to assess tubal patency, however, the diagnostic reliability of this technique is not known. Two hundred thirty-one consecutive hysterosalpingograms were retrospectively evaluated. Sixty-two percent (143) of the patients subsequently underwent laparoscopy. Comparison of hysterosalpingogram and laparoscopic findings revealed a 15.9% false positive tubal patency rate and a 14.9% false negative tubal patency rate. Seventy-six percent of laparoscopies revealed previously undiagnosed intraperitoneal disease. Seventeen percent of hysterosalpingograms demonstrated intrauterine pathology. There was a 0.9% major complication rate with hysterosalpingograms due to two cases of acute pelvic inflammatory disease. No significant laparoscopic complications were noted. The results suggest that laparoscopy provides a more accurate assessment of tubal patency and peritoneal factors than hysterosalpingogram in the investigation of infertility.
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PMID:Reevaluation of hysterosalpingography in infertility investigation. 293 35


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