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Pelvic Inflammatory Disease

From Mediwikis

Pelvic inflammation typically caused by an ascending Sexually transmitted infection.

Causes

  • Ascending STI of vagina or cervix (80%)
  • Uterine instrumentation (coils, TOP, laparoscopy)
  • Complications of childbirth or miscarriage
  • Descending infection from other organs (e.g. appendix)

Infection is typically polymicrobial, but chlamydia is present in up to 60% of cases.

Signs and Symptoms

Symptoms

Signs

  • Tachycardia
  • Pyrexia
  • Lower abdo tenderness
  • Cervical excitation
  • Palpable mass
  • Fixed Retroverted uterus

Investigations

  • Endocervical swabs (for chlamydia)
  • Bloods – Blood cultures, WBC and CRP
  • Pelvic Ultrasound Scan
  • Laparoscopy and biopsy (gold standard)

Management

  • Antipyretics and IVT
  • Antibiotics – cephalosporin followed by metronidazole or doxycycline
  • Review after 14hrs if no improvement and perform laparoscopy
  • Drain any abscess found (rupture abscess can be life threatening

Complications