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

Sixty-nine patients with tubal infertility secondary to pelvic inflammatory disease were surgically treated by one of three infertility surgeons, who used microsurgery for repair of the tubal pathologic condition and early second-look laparoscopy 6 to 30 days postoperatively for lysis of postoperative adhesions. No patient was included in this group whose disease was thought to have originated from endometriosis or prior abdominal surgery. The average follow-up time was 43.1 months (range 12 to 85.9). Nine patients were excluded from the analysis. Pregnancy outcome by procedure, expressed as the percentage of patients conceiving, was as follows: adhesiolysis, 69% (61% term, 8% ectopic); fimbrioplasty, 35% (25% term, 10% ectopic); salpingostomy, 30% (18% term, 12% ectopic); and cornual implantation, 60% (40% term, 20% ectopic). No added therapeutic value could be attributed to the use of early second-look laparoscopy. Given the relatively poor outcome of fimbrioplasty and salpingostomy, it may be prudent to advise patients with bilateral partial and/or total tubal occlusion against tuboplasty in favor of in vitro fertilization and embryo transfer.
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PMID:Results of microsurgical treatment of tubal infertility and early second-look laparoscopy in the post-pelvic inflammatory disease patient: implications for in vitro fertilization. 294 Aug 68

We used second laparoscopy with dye insufflation to evaluate tubal findings in 20 women 15-45 weeks after treatment for acute pelvic inflammatory disease. Eight women had pelvic adhesions, including all six women with adhesions seen at first laparoscopy. However, in five of the six women, adhesions were milder or had disappeared unilaterally. Dye insufflation revealed tubal occlusion in five of eight women with adhesions and one of 12 women without adhesions. Thus, nine women (45%) had pelvic adhesions or tubal occlusion at second laparoscopy. Second laparoscopy is useful to objectively assess posttreatment tubal and peritubal morphology. Larger studies are needed to evaluate the cost-effectiveness of the procedure and the correlation of second laparoscopy findings to future infertility.
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PMID:Second laparoscopy after treatment of acute pelvic inflammatory disease. 295 Mar 48

The level of tumor necrosis factor (TNF) in peritoneal fluid (PF-TNF) of 74 women undergoing laparoscopy was determined. The difference between the mean concentration of PF-TNF of women with normal pelvic anatomy and women with moderate or severe endometriosis was significant (P less than 0.01). The proportion of PF-TNF-positive women with PID and those with moderate or severe endometriosis was also significantly higher when compared to women with normal pelvic anatomy (P less than 0.05; P less than 0.02). The proportion of PF-TNF positive women among nulligravid and nulliparous women was significantly higher than that of women with two or more pregnancies (P less than 0.01) and two or more deliveries (P less than 0.005). These results indicate that the presence of PF-TNF is associated with primary infertility and endometriosis.
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PMID:Tumor necrosis factor in peritoneal fluid of women undergoing laparoscopic surgery. 297 79

Three treatment regimens are currently recommended for penicillin-susceptible Neisseria gonorrhoeae infection of the cervix: ampicillin, tetracycline, and a combination of ampicillin and tetracycline. To evaluate the cost-effectiveness of these options, we developed a decision analysis model and analyzed the efficacy of each treatment in curing gonorrhea, as well as coexisting Chlamydia trachomatis infection, and in preventing subsequent pelvic inflammatory disease, ectopic pregnancy, and infertility. We included direct costs of medication and expenditures for management of unresolved infections and associated complications. Combination treatment is more than twice as cost-effective as tetracycline and seven times as cost-effective as ampicillin when the medical cost of managing pelvic inflammatory disease is considered. When the costs of ectopic pregnancies and infertility are included, the cost-effectiveness of combination treatment increases further.
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PMID:Cost-effectiveness of combined treatment for endocervical gonorrhea. Considering co-infection with Chlamydia trachomatis. 310 27

Antibody-based methods for the diagnosis of Chlamydia trachomatis infection of the cervix have recently made population screening programs possible for this epidemic and frequently asymptomatic problem. We constructed a decision model, using medical care costs as utilities, to determine the total costs of screening and of not screening in California state-funded family planning clinics, and to determine the prevalence of infection at which such screening could be expected to pay for itself. A net savings of $6 million would be realized in the first year, with annual savings eventually increasing to over $13 million, from the prevention of chlamydia-associated pelvic inflammatory disease and other long-term sequelae such as tubal infertility and ectopic pregnancy. Over $60 million could be saved in the first five years of such a statewide screening program. In populations with infection prevalence of 2% or more, such screening will pay for itself and can be considered "cost-effective." Screening of asymptomatic women for chlamydia should be carried out in most American family planning clinics.
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PMID:A cost-based decision analysis for Chlamydia screening in California family planning clinics. 312 37

A significant proportion of women with PID will have their disease complicated by a TOC. We conclude that it is appropriate in women with this stage of PID to treat initially with clindamycin and an aminoglycoside. In addition, since more than half of the women will suffer reproductive difficulties, efforts to improve early diagnosis and therapy should continue. Based on our data, an early infertility evaluation is indicated in women wishing to conceive after complicated PID.
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PMID:Reproductive outcome after medical management of complicated pelvic inflammatory disease. 316 91

Pelvic inflammatory disease is a common cause of tubal infertility. The pregnancy outcomes in 161 patients who underwent primary microsurgical tuboplasty for postinflammatory tubal disease at the Mayo Clinic from 1977 through 1981 were evaluated. The outcome (3-year rate) was evaluated for each category of microsurgical procedures. The proximal anastomosis group had a conception rate of 71% (50% live births, 30% spontaneous abortions, 6% ectopic pregnancies). The terminal salpingoneostomy group, which accounted for the largest number of procedures, had a conception rate of 47% (32% live births, 12% spontaneous abortions, 11% ectopic pregnancies). Even after microsurgical tubal reconstruction, most women do not achieve a live birth. Pregnancy outcome is probably related to several factors reflecting the severity of pre-existing intrinsic damage. Prognostic factors that may better predict pregnancy outcome are discussed.
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PMID:Primary microsurgery for postinflammatory tubal infertility. 320 49

There has been a change in the causative organisms of pelvic inflammatory disease over recent years - Chlamydia trachomatis is now the commonest infecting organism. Pelvic inflammatory disease is often managed in general practice and it is important that each episode is treated adequately in order to prevent recurrent infection, with its short term morbidity and long term risk of infertility and ectopic pregnancy.In an attempt to document the current management of pelvic inflammatory disease in general practice, a questionnaire was sent to all 143 general practitioners in the Torbay area health authority. The response rate was 78.3%. Investigation methods and treatment regimens varied, with almost half (46.4%) of the respondents taking endocervical specimens but only 25.0% providing antibiotic therapy against C. trachomatis. Only 39.3% of the doctors considered investigation or referral of the male partner.It is concluded that general practitioners are willing to participate in clinical audits of this kind and that the management of pelvic inflammatory disease in general practice is often incomplete.
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PMID:Audit of the management of pelvic inflammatory disease in general practice. 325 83

An analysis of published studies of the effect of antibiotic prophylaxis associated with vacuum aspiration abortion includes an examination of risk factors for pelvic inflammatory disease (PID), cervical and vaginal flora present in early pregnancy and in PID, the effect of surgical scrub and of prophylaxis on flora, principles of antibiotic prophylaxis, and economic costs of PID. From several prospective studies, it is clear that nulliparas, women with a history of PID, those bearing Chlamydia trachomatis are at risk of post-abortion infection. No risk was associated with pelvic pain, dysmenorrhea, social class, insertion of an IUD, or timing of resumption of coitus. After an extensive enumeration of microbes found in nonpregnant, pregnant, and PID female genital tracts, it was concluded that only C. trachomatis and N. gonorrheae are clearly associated with PID, while the importance of several other microbes is unclear. Quantitative counts of organisms in any condition are lacking. PID is polymicrobial; different organisms probably account for noniatrogenic PID and post-surgical PID. There is evidence that surgical cleansing of the vagina has no bearing on incidence of post-abortal PID, since the responsible organisms come from the endocervix. 5 controlled clinical trials demonstrated that antibiotic prophylaxis is warranted; that penicillin/ampicillin selectively reduced PID in women with PID history; that imidazoles preferentially reduce PID in the general population without PID history. No lasting side effects or emergence of resistant organisms was reported. The treatment was cost effective, cutting health costs and labor losses 5-8%, and reducing the incidence of spontaneous abortion, secondary infertility, and chronic pain.
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PMID:Pelvic inflammatory disease following induced first-trimester abortion. Risk groups, prophylaxis and sequelae. 327 98

The epidemic of sexually transmitted diseases has placed young, sexually active women at risk of infertility from tubal and pelvic factors. Salvaging reproductive function in women desiring fertility depends upon an accurate diagnosis and early, aggressive therapy for all cases of salpingitis. Conservative surgical management of tubal pregnancy in such women is now standard practice. Less-aggressive surgical approaches to chronic pelvic inflammatory disease and even tuboovarian abscess, when possible, can preserve some part of the pelvic anatomy in these women, who may then undergo reconstructive pelvic surgery or in vitro fertilization. Due to the recent technological revolution in infertility therapy, preservation of a women's uterus alone is all that is necessary to sustain the hope for a pregnancy.
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PMID:Preservation of fertility in women with pelvic inflammatory disease. 327 9


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