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2 Pid
2 Pid
• acute salpingitis.
Minor criteria
-oral temperature >38.3°C (101.6°F),
-mucopurulent cervical or vaginal discharge,
-abundant WBCs on saline microscopy of cervical secretions,
-elevated erythrocyte sedimentation rate (ESR) or
-C-reactive protein (CRP), and
-presence of cervical N gonorrhoeae or C trachomatis.
The most specific criteria:-
Endometrial biopsy with histopathologic evidence of
endometritis
Transvaginal sonography or MRI
• Imaging studies
– Ultrasound
– MRI
– Laparoscopy
Laparoscopy
Tubal serosal hyperemia,
Tubal wall edema, and
Purulent exudate issuing from the fimbriated ends of the
fallopian tubes and
Pooling in the cul-de-sac
= Sonography
= CT scan
= Endometrial biopsy
- Polymorphonuclear leukocytes
Grading of severity
Clinical system
Grade I: Disease limited to the adnexae
Grade II: PID with an inflammatory mass
Grade III: Ruptured tubo-ovarian abscess pelvic
peritonitis
laparoscopic system
Mild: Erythema and edema of the adnexae
Moderate: Purulent exudate from fallopian tubes
Severe: Pyosalpinx, inflamatory complex, TOA
Gainesville staging of acute salpingitis
• Out patient
• Inpatient
Treatment
• based on the consensus that PID is
polymicrobial in cause.
• Regimen B
- Ceftriaxone 250 mg IM in a single dose
PLUS
- Doxycycline 100 mg orally twice a day for 14 days
WITH OR WITHOUT
- Metronidazole 500 mg orally twice a day for 14 days
• PATIENT MONITORING — patient should be seen within 48 to 72 hours
Criteria for inpatient RX
• Adolescents
• Drug addicts
• Severe disease
• Suspected abscess
• Uncertain diagnosis
• Generalized peritonitis
• Temperature >38.3° C
• Failed outpatient therapy
• Recent intrauterine instrumentation
• White blood cell count >15,000/mm3
• Nausea/vomiting precluding oral therapy
Criteria for Hospitalization (CDC 2002)
• Percutaneous drainage
• Laparascopy
• Laparatomy
Indication for surgery