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Pelvic inflammatory disease

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  • 1. PELVIC INFLAMMATORY DISEASE Dr. Richa Katiyar IVF and Infertility Specialist, New Delhi, India Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
  • 2. PID Spectrum of inflammatory disorders involving endometrium, uterus, fallopian tubes and ovary. Endometritis Salpingitis Tubo-ovarian Abscess Pelvic peritonitis Generalised peritonitis Septicaemia Late sequelae: Tubal blocks, infertility, Ectopic pregnancy, Chronic pelvic pain Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
  • 3. PID – Risk Factors STDs – Strong association with PID Age of 1st intercourse No. of sexual partners Frequency of coitus IUCD (3 to 4 fold increase)- multifilament string. Surgical procedures (ascending infection) e.g. D&C, MTP, HSG, Hysteroscopy Previous acute PID Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
  • 4. PID – Diagnosis CDC – 2002: Minimum criteria Lower abdominal pain Cervical motion tenderness Uterine/adnexal tenderness Additional Criteria: Fever Abnormal mucopurulent cervical/vaginal discharge ­ ESR ­ C Reactive Protein Leukocytosis ­ WBC on saline microscopy of vaginal secretions Lab diagnosis of cervical infection with N. gonorrhoea or C. trachomatis Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
  • 5. PID – Diagnosis Specific criteria: Histopathologic evidence of endometritis TVS/MRI: thickened tube T.O. abscess/mass, free fluid in peritoneal cavity Laparoscopic evidence of PID Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
  • 6. PID - Management Inpatient Parenteral treatment - CDC guidelines Regimen A Cefotetan 2gm I.V. 12 hrly OR Cefoxitin 2 gm I.V. 6 hrly + Doxy 100mg I.V. 12 hrly Continue for 24 hours after improvement, followed by Doxy 100 mg BD x 14 d oral + Metro/ Clindamycin (14 d) added if TO abscess Regimen B Clindamycin 900mg I.V. 8 hrly + Genta 2 mg/kg body wt. 8 hrly Continue for 24 hours after improvement, Continue Doxy 100mg BD x 14 d Or Clindamycin 450mg QID x 14 d Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
  • 7. PID - Management Inpatient Parenteral treatment - CDC guidelines Regimen A Cefotetan 2gm I.V. 12 hrly OR Cefoxitin 2 gm I.V. 6 hrly + Doxy 100mg I.V. 12 hrly Continue for 24 hours after improvement, followed by Doxy 100 mg BD x 14 d oral + Metro/ Clindamycin (14 d) added if TO abscess Regimen B Clindamycin 900mg I.V. 8 hrly + Genta 2 mg/kg body wt. 8 hrly Continue for 24 hours after improvement, Continue Doxy 100mg BD x 14 d Or Clindamycin 450mg QID x 14 d Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com