Pelvic inflammatory disease

Ms Bincy
• It is a polymicrobial infection of the upper
genital tract in women
• It includes a spectrum of inflammatory disorders
like endometritis , parametritis, salpinngitis,
oophoritis, tubo ovarian abscesss, pelvic
peritonitis
Risk factors
• At risk of STIs
• With a prior episode of PID
• Who are sexually active under age of 25 yrs of age
• Who practise douching
• Using an IUD
• With multiple sexual partners
• Who had previous delivery by untrained birth
attendant
• With intra abdominal focus of infection like
appendicitis
• With past history of criminal abortion
Causes
• Chlamydia trachomatis
• Neisseria gonorrhea
• Gardenella vaginalis
• H. influenzae
• Gram negative rods
• Streptococcus agalactia
Clinical features
• Pain in lower abdomen
• Dyspareunia
• Fever
• Back pain
• Vomiting
• Abnormal vaginal discharge / bleeding
• Itching and odor
Daignosis
• Bloood: leucocytosis, increase in CRP,ESR
• Vaginal / cervical swab-gram staining, C/S
• Laparoscopy- direct visualisation of purulent
exudates and edema of pelvic structures
• TVUS- detects fluid collection within the pelvis,
such as tuboovarian abscess or pyosalpinx
• CT scan- thickening of uterosacral ligaments
• MRI- thickened tubes with fluid collection
Complications
• Acute
▫ Pelvic abscess
▫ Tubo-ovarian abscess
▫ Pyosalpinx
▫ Peritonitis
▫ Abscess: perinepric, tubal, subdiaphragmatic
▫ Paralytic ileus
▫ Septicemia
▫ Metastatic abscess
Complications…
• Chronic
▫ Chronic tubo-ovarian cyst
▫ Chronic pyosalpinx
▫ Chronic salpingitis
▫ Frozen pelvis due to adhesions causing intestinal
obstruction, ectopic pregnancy
▫ Infertility
Treatment CDC
• Parentral regimen A
▫ Cefotetan 2gms iv q12 h or
▫ Cefoxitin 2gms iv q6h
PLUS
▫ Doxycycline 100mg oral or iv q12 h
• Parentral regimen B
▫ Clindamycin 900 mg iv q8h
Plus
▫ Gentamycin 2mg/kg followed by 1.5mg/kgq 8h
• Alternative regimens
▫ Ampicillin/sulbactum 3gms iv q6h plus
▫ Doxycycline 100mg oral or iv q12 hr
Treatment CDC
• Oral regimen
▫ Ceftriaxone 250mg im in single dose
Plus
▫ Doxycycline 100mg oral twice a day for 14 days
With or without
▫ Metronidazole 500mg oral tiwce a day for 14 days
Treatment
• Cefoxitin 2gm im in single dose and probenecid
1gm oral
plus
• Doxycycline 100mg oral twice a day for 14 days
with or without
• Metronidazole 500mg oral twice a day for 14
days
Surgery
• Acute PID
▫ Colpotomy and drainge of abscess
▫ Laparatomy and drainage of pus
▫ Dilatation and evacuation of products of
coneption in case of hemorhage
▫ Laparascopic drainage
▫ Ultrasound guided aspiration
▫ Percutaneous drainage
• Chronic PID
▫ Salpingectomy
▫ SPO
▫ Hysterectomy
▫ In case of infertility
 Tuboplasty
 Adhesionolysis
 Laparoscopic salpingoscopy
Prevention
• Safe sex practices
• having a single partner
• Safe delivery practices
• Screening of high risk women