Pelvic inflammatory disease (PID)

Abstract

Introduction.Pelvic inflammatory disease is an infection of the upper genital tract (uterus, uterine tubes, ovaries). It is usually an ascending infection from the lower genital tract - bacteria spreading directly from the cervix to the endometrium and to the upper genital tract. Most cases of PID are related to a sexually transmitted infection (85% cases), but may also include gynecological procedures, 15% cases (IUD insertion, pregnancy interruption, hysterosalpingography, endometrial biopsy, etc.), because they favor the transfer of bacteria from the vaginal level through the uterine cervix to the upper genital tract. Aim of the study. Studying the particularities of diagnosis and management of pelvic inflammatory disease. Materials and methods. This is a retrospective study based on 52 women diagnosed with pelvic inflammatory disease admitted in the Department of Obstetrics and Gynecology SCM,,Sfântul Arhanghel Mihail” during 2018. Results. The average age in the study is 32.46 years. Pelvic inflammatory disease is most common, according to literature , among sexually active women. According to the age distribution : in the age group ≤ 29 years were registered 25 (48.1%) patients, in the age group 30-39 years were 16 (30.7%) patients, 40-49 years were 7 (13.5%) patients, 50-59 years were 4 (7.7%) patients, no patients were older than 60 years. According to the age in the study group, the highest rate of 48.1% is observed in the age group below 29 years, with a subsequent reduction of the cases of pelvic inflammatory disease in the age group 30-39 years, 30.7% ,with a decrease in the age categories 40-49 years, 13.5% and 50-59 years, 7.7%. According to the origin, there were 17 (32.7%) patients from the rural area and 35 (67.3%) patients from the urban area. According to the work place, 31 (59.6%) patients were employed, unemployed 11 (21.2%) patients, students 9 (17.3%) patients, invalidity degree 1 (1.9 %) patient. According to patient symptoms, pain of different intensity in the lower hypogastric region had 100% patients, subfebrility 7 (13.5%) patients, temperature> 38C had 10 (19.2%) patients, purulent leucorrhea 11 (21.1%) patients, primary or secondary sterility 16 (30.8%) patients, general weakness 16 (30.8%) patients, bloody vaginal eliminations 2 (3.8%) patients, painful urination 2 (3.8%) patients, polymenorrhea 1 (1.9%) patient, menometrorrhagia 1 (1.9%) patient. According to the final clinical diagnosis: chronic salpingoophoritis 22 (42.3%) cases, hydrosalpinx 11 (21.2%) cases, tube-ovarian abscess 4 (7.7%) cases, chronic salpingitis 5 (9.6%) cases, acute salpingoophoritis 7 (13.5%) cases, torsioned hydrosalpinx 2 (3.8%) cases, acute inflammatory disease, pain syndrome 1 (1.9%) case. According to the management method of the cases of pelvic inflammatory disease diagnosed, 25 (48.1%) cases were surgically managed, conservatively 27 (51.9%) cases. From the surgeries performed, 25 (100%) interventions, 13 (52%) were surgical laparoscopes, 5 (20%) Pfannenstiel laparatomas, 4 (16%) lower median laparatomas, 1 (4%) diagnostic laparoscopy, 2 (8 %) puncture of the posterior fornix. The 25 surgical procedures performed were : salpingolisis was performed in 5 (20%) cases, adesiolysis in 11 (44%) cases, tubectomies in 6 (24%) cases, anexectomies 4 (16%) cases, salpingectomies 4 (16%) cases, cystectomies 2 (8%) cases, cyst perforation 3 (12%) cases, ovarian dreeling 2 (8%) cases, myomectomy 1 (4%) case, total hysterectomy with bilateral anexectomy 1 (4% ) case, subtotal hysterectomy with salpingoectomy 1 (4%) case. Conclusions. The actual incidence of PID can not be estimated, as all cases of PID are not mandatory reported. PID affects about 11% of women of reproductive age, with the highest frequency in the age group 16-25 years. Acute pelvic inflammation is recorded annually in 1- 2% sexually active women. PID is a public health problem, due to its frequency, medical, social and economic implications. The diagnosis of PID should primarily be suspected in women with lower hypogastric pain and genital tract sensitivity. PID morbidity is high and constantly increasing, requiring huge expenses, days of hospitalization and recovery. Short-term complications of PID include tubeovarian or pelvic abscess. Long-term complications of PID include infertility, ectopic pregnancy, chronic pelvic pain. Early diagnosis and treatment can prevent complications.