Inflammation in the pelvis. Treatment of inflammatory diseases Pelvic inflammatory diseases treatment

Pelvic inflammatory disease is an ascending infection of the uterus, its appendages and the pelvic peritoneum.

These include:

endometritis (inflammation of the lining of the uterus);
metroendometritis (inflammation of the mucous and muscular lining of the uterus);
parametritis (inflammation extends to the periuterine space);
salpingoophoritis (inflammation of the uterine appendages - tubes and ovaries);
pelvioperitonitis (common inflammation, including the pelvic peritoneum).

You can get information about the most common inflammatory diseases of the pelvic organs in this section.

Endometritis

Acute endometritis Most often occurs after abortion, childbirth or diagnostic curettage of the uterus. Clinical signs of acute endometritis usually appear 3-4 days after infection. The temperature rises, the pulse quickens, there is chilling, there are all signs of an inflammatory process in the body and according to a clinical examination. The discharge is serous-purulent, often sanguineous for a long time, which is associated with a delay in the regeneration of the mucous membrane. The acute stage lasts 8-10 days. With proper antibacterial treatment, the process ends and less often becomes subacute or chronic.

Chronic endometritis The incidence of chronic endometritis averages 14%. In recent years, there has been a tendency towards its increase, which is associated with the widespread use of intrauterine devices and the increase in the number of abortions.

As a rule, chronic endometritis occurs as a result of untreated acute postpartum or post-abortion endometritis; its development is often facilitated by repeated intrauterine interventions due to uterine bleeding.

The diagnosis can be indirectly made by ultrasound signs, but it can be 100% confirmed only by hysteroscopy and histological examination of the endometrium!!

Quite often, chronic endometritis is a uterine factor of infertility, and requires long-term and serious treatment after confirmation of the diagnosis.

When the infection spreads upward from the uterine cavity into the fallopian tubes, salpingoophoritis develops, i.e. inflammation of the uterine appendages.

Salpingo-oophoritis

Salpingoophoritis is the most common form of inflammatory diseases of the pelvic organs. Every fifth woman who has suffered inflammation of the uterine appendages faces infertility, which is associated with the development of adhesions in the pelvis!

It is known that the fallopian tubes are most often affected by bacterial infections. This is due to the characteristics of the blood supply and anatomical structure. However, the depth of damage to the tissue of the fallopian tubes depends on the pathogen that caused the inflammation and the duration of the process.

Characteristic signs of inflammation of the uterine appendages: increased body temperature, pain in the lower abdomen, pain during gynecological examination, characteristic ultrasound signs.

Currently, in half of the patients, inflammation of the appendages has a mild, or rather, almost asymptomatic course! This complicates diagnosis, delays the appointment of timely correct treatment, leads to the formation of adhesions in the pelvis and infertility.

Quite often, patients simply do not know that they have previously suffered inflammation of the uterine appendages, and only with a substantive interview is it possible to identify erased but characteristic complaints.

Salpingitis (inflammation of the fallopian tubes)

Acute salpingitis begins with swelling of the mucous membrane of the tube, the cilia covering the inside of the fallopian tubes are affected, and inflammatory fluid accumulates in the tube. If untreated, the fallopian tube fills with pus, which flows from the fallopian tubes into the pelvis, which leads to inflammation of the peritoneum (peritonitis) and the formation of adhesions. Inflammation also leads to tissue destruction, which is accompanied by the formation of abscesses (demarcated cavities filled with pus, which also contain destroyed organs when they are involved).

The accumulation of fluid in the pipe leads to its stretching, which is called “hydrosalpinx (salpinx - pipe; hydro-fluid). When it suppurates, a “pyosalpinx” is formed, literally, pus in the tube (pyo-pus). In this situation, emergency surgical treatment is required to avoid the spread of purulent inflammation to other organs of the pelvis and abdominal cavity.

Figure 1. Dilated fallopian tube with fluid contents.

The figure shows an enlarged fallopian tube with liquid contents. The vascular pattern is pronounced. Laparoscopy was performed 6 hours after the onset of the disease. The inflammation has not yet reached the purulent stage. It is planned to perform plasty of the fallopian tube, washing the abdominal cavity and pelvis with solutions of antiseptics and antibiotics.

Chronic salpingitis- is the predominant form of inflammatory diseases of the pelvic organs. The process may be a continuation of the acute one, however, it is possible that at the beginning of the disease there were no symptoms inherent in the acute stage. Most often, chronic salpingitis is the result of untreated acute salpingitis.

It has been established that the chronic stage is characterized by the presence of infiltrates, loss of physiological functions of the mucous and muscular membranes of the fallopian tube, development of connective tissue; with a long course, obstruction of the fallopian tubes often occurs with or without the formation of hydrosalpincos, with the formation of adhesions around the ovaries. Formed adhesions prevent the capture of the egg, which is also one of the causes of infertility.

Clinical manifestations chronic salpingoophoritis is varied, some symptoms are associated primarily not with changes in the uterine appendages, but with neurosis, which is often observed with a long course and frequent relapses.

The main complaint is dull, aching pain, worsened by cold, colds or during menstruation. “Referred” pain is also characteristic, which is usually felt in the groin areas, in the sacral area or in the vagina. Half of the patients have menstrual dysfunction, since chronic inflammation also leads to disruption of the ovaries (decreased function, lack of ovulation).

Anatomical and functional changes in the fallopian tubes and disruption of the ovaries during chronic inflammation are the cause of infertility, and also lead to pathological outcomes during pregnancy (spontaneous miscarriages, ectopic pregnancy)!!!

Diagnostics

The ultrasound method is not sufficiently informative in diagnosing salpingoophoritis. It allows you to identify only space-occupying formations in the pelvis. Those. With ultrasound, it is possible to see the fallopian tubes, which are filled with fluid (with hydro- or pyosalpinx), as well as with the formation of abscesses (with purulent melting of the fallopian tubes and ovaries). Therefore, the diagnosis of acute inflammatory diseases of the uterine appendages is mainly based on clinical data and gynecological examination data.

Treatment

Treatment of patients with acute salpingoophoritis should be carried out in a hospital setting.

The main place in treatment belongs to antibiotics, the effectiveness of which is determined by the properties of the pathogen and its sensitivity.

In the formation of purulent inflammation of the uterine appendages, the only effective method for 100% diagnosis, treatment and preservation of fertility is laparoscopy!!!

Chronic diseases of the uterine appendages are accompanied by the formation of adhesions in the pelvis, which disrupts the patency of the fallopian tubes, leads to infertility and also requires planned surgical treatment (laparoscopy).

Pelvioperitonitis

Pelvioperitonitis (inflammation of the pelvic peritoneum) is one of the most dangerous complications of inflammatory diseases of the pelvic organs and already poses a threat to a woman’s life!

This complication occurs secondary to the penetration of microorganisms from the fallopian tube. The primary focus of infection can be not only in the fallopian tubes, but also in the ovaries, uterus, pelvic tissue, appendix and other organs.

If treated incorrectly, the development of pelvioperitonitis is accompanied by septic shock, which is one of the causes of death in patients.

With the development of this complication, immediate surgical treatment in an adequate volume is required, aimed primarily at removing the source of purulent infection!!!

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

The inflammatory process of the pelvic organs does not mean one specific disease, but a group of pathological processes in the body. These include:

Inflammation of the fallopian tubes in a woman - salpingitis;
Severe inflammation of the ovaries - oophoritis;
Salpingoophoritis is an inflammatory process of the uterus, fallopian tubes and ovaries;
Vaginitis (colpitis) is an inflammatory process in the vaginal mucosa;
– pathology in which inflammation of the entrance (vestibule) of the vagina occurs;
Vaginosis caused by penetration of pathogenic bacteria into the vagina;
Parametritis is an inflammatory process of periuterine tissue;
An inflammatory process of the abdominal cavity called pelvioperitonitis.

All these pathologies relate to severe acute inflammatory processes of the pelvic organs. Each of these pathologies has its own consequences, which affect the woman’s general well-being, reproductive function, sex life, etc.

Symptoms of inflammatory processes

If you experience at least one of the following symptoms, this means that you need to urgently consult your doctor. Self-medication or ignoring the disease is under no circumstances allowed. The consequences of untreated inflammatory processes of the pelvic organs can indeed be extremely severe, ranging from menstrual irregularities to infertility.

We list the main symptoms of inflammatory diseases of the pelvic organs:

Concomitant symptoms of the inflammatory process are irregular periods in women or complete disruption of the menstrual cycle. In this case, there may be pain when urinating, pain in the urethra. Against the background of general malaise, a woman may develop a gag reflex, diarrhea, and diarrhea. Physical state of fatigue, weakness, fever.

Causes of the inflammatory process

Why can a woman develop inflammatory processes in the vagina? Let's look at the main reasons for this phenomenon.

The inflammatory process may begin to develop after a recent surgical abortion or difficult childbirth (with complications). In some cases, the infection can enter the vagina from the inflamed, infected appendix, from the affected rectum.

A pathological course such as vulvitis appears due to mechanical damage (this can be scratching of the vagina due to severe itching, as a result - the appearance of abrasions and scratching). As is known, infection penetrates faster into an open wound and affects surrounding tissues.

Endometritis, which is classified as an acute inflammatory process in the uterine mucosa, appears in a woman after a medical or surgical abortion, curettage of the uterine mucosa for medical reasons.

Factors influencing the occurrence of the inflammatory process

The main factors that influence the course of the inflammatory process are:

Carrying out several abortions over 1-2 years;
Intrauterine interventions;
Long-term wearing of an intrauterine device;
Surgical;
Constant change of sexual partners;
Previously untreated inflammatory processes of the pelvic organs;
Difficult labor;
Violation of personal hygiene rules (using other people's towels, soap, infrequent washing during the day).

Diagnosis of inflammatory process of the uterus

If a woman experiences unpleasant symptoms in the genital area, she should consult a gynecologist as soon as possible. You should not delay this, otherwise it can lead to serious consequences in the form of infertility.

An experienced gynecologist can determine the presence of an inflammatory process in a patient during a routine examination and questioning of symptoms. When the doctor begins to touch the uterus, painful sensations may arise that are quite difficult for the woman to endure.

To confirm the presence of an inflammatory process, it will be necessary to take smears of mucus from the vagina, as well as the cervix. During an infectious-inflammatory process in a woman, pathogens of the disease will be found in the vaginal mucus - viruses, infections, fungal microorganisms, Trichomonas, gonococci, ureplasma, mycoplasma, E. coli and more.

You will also need to take a blood test - based on the results of the analysis, leukocytosis will be detected during the inflammatory process. According to an ultrasound examination, the patient will be found to have a pathological enlargement of the ovaries, the size of the appendages, as well as the formation of foci of purulent accumulation, infection and inflammation.

Treatment of inflammation in the vagina

If the patient is diagnosed with vulvovaginitis, then treatment will be exclusively outpatient. If the inflammatory process is mild, then treatment can take place at home with the help of drug therapy.

To eliminate the inflammatory process, the medications most often used are Metronidazole, Clindamycin, and Tinidazole. If a woman is diagnosed with inflammation in the vagina, her partner must also undergo treatment, otherwise such therapy will not make sense.

Obstetricians and gynecologists have found that in 80% of women, pain in the lower abdomen is associated with local dilation of the veins. Stagnation of blood in the pelvis causes a number of painful manifestations in men. The organs located in this zone perform different functions, but are interconnected by common blood circulation. Therefore, the disease of one can quickly spread to neighboring areas.

Treatment will not lead to positive results without restoring the outflow of venous blood.

What is the “small pelvis” and what is in it?

The “small pelvis” is an anatomical bone formation. In front it is represented by the pubic bones, in the back by the sacrum and coccyx, on the sides by the lower part of the ilium. Vertically, one can distinguish the entrance at the level of the ischial joint and the outlet formed by the coccyx, the ischial tuberosities, and the lower branches of the pubic symphysis.

The bone frame is designed to protect the organs lying inside. In people of both sexes, the rectum is located here. Its task is to accumulate and remove waste waste from the body. It lies directly on the sacrum. It has a length of up to 15 cm in an adult and stretches in diameter up to 8 cm.

The bladder lies behind the fatty tissue and pubic bones. When overfilled, the top edge protrudes above the joint.

Among women

In the small pelvis are located:

ovaries - the place where eggs mature, sex hormones are produced and enter the blood;
the uterus is an unpaired organ, similar to a pear, located with its tail down, lies between the bladder and rectum, narrows at the bottom and passes into the cervix and vagina;
vagina - has the shape of a tube up to 10 cm long, connects the genital slit and the cervix.

In men

The male organs in the pelvis are:

prostate gland - produces a secretion that is part of sperm, located below the bladder;
seminal vesicle - length 5 cm, width 2 cm, a secretory organ that brings its product out through the ejaculatory duct.

All organs are supported by dense ligaments of connective tissue.

Features of blood supply

Arterial blood comes from the abdominal aorta through the iliac arteries. The veins accompany the arteries, run parallel, and form venous plexuses around each organ. An important feature of local venous blood flow:

a wide network of anastomoses, which, on the one hand, provides auxiliary outflow in case of thrombosis, and on the other hand, infection quickly spreads between adjacent anatomical structures;
unlike the veins of the extremities, the vessels do not have a valve apparatus, which causes rapid stagnation of blood in the pelvic organs;
venous trunks located along the bone skeleton are tightly attached to the walls of the pelvis, so in case of bone injuries they do not collapse, but are wide open, which contributes to blood loss.

Why does stagnation occur?

The causes of blood stagnation in the pelvic veins are associated with damage to the vascular wall or a mechanical obstacle to the blood flow:

varicose veins - occurs due to a violation of the structure, elasticity, loss of hyaluronic acid by cells, hereditary predisposition;
alcoholism and nicotine addiction - both factors destroy hyaline and cause varicose veins;
disturbance of central regulation of blood vessels, spasm, which turns into loss of tone in diseases of the nervous system;
prolonged sitting position at work, lack of movement during the day;
irrational diet, passion for different diets that cause vitamin deficiency, constipation;
For women, pregnancy history, uterine flexion and the use of hormonal contraceptives are important.

Wearing shapewear, corsets, belts, interferes with the outflow of venous blood, the pursuit of beauty leads to pathology

Clinical manifestations

Symptoms caused by blood stagnation cannot be considered typical, since they also occur in other diseases. But they should be remembered in the differential diagnosis of diseases.

Both men and women complain about the following:

pain in the lower abdomen is prolonged, aching in nature or sharp, stabbing, radiating to the lower back, thigh, perineum;
feeling of heaviness.

Accompanying various diseases, circulatory pathology manifests itself in different ways:

stagnation of blood in the pelvis in women and men causes infertility;
as one of the causes of inflammatory diseases in men, urethritis develops, prostatitis with pain when urinating, pain in the perineum, impotence;
varicocele as a variant of varicose veins in men causes testicular enlargement on one side and pain;
in women, the uterus prolapses, the menstrual cycle is disrupted, and bleeding increases;
chronic hemorrhoids with pain in the anus, burning and itching.

With a long course of the disease, general symptoms are observed regarding changes in a person’s mental state: depression or anxiety, irritability, and tearfulness appear.

Diagnostics

If stagnation in the pelvis is suspected, doctors use hardware examination methods to confirm or remove the diagnosis:

Ultrasound - assesses the size of organs and the state of blood flow;
venography - a contrast agent is injected into the inguinal vein followed by an x-ray; the procedure carries the risk of an allergic reaction to the drug;
computed tomography - allows you to identify local varicose veins;
magnetic resonance imaging - reveals signs of inflammation, changes in the location and shape of the pelvic organs, the structure and direction of blood vessels.

Treatment requirements

In addition to drug therapy, the treatment complex necessarily includes gymnastic exercises and a diet. It is necessary to achieve normalization of sleep, quit smoking, and limit the consumption of alcoholic beverages.

The diet should include everything that prevents stool retention: liquid up to 2 liters per day, vegetables and fruits, fermented milk products, exclude sweets, fried and spicy foods. Replace fatty meat products with fish and poultry. Due to increased gas formation, it is better to exclude dishes made from legumes and cabbage.

What exercises can you do at home?

swimming;
jogging;
jumping rope;
yoga.

This physical activity simultaneously trains the heart and blood vessels.

At home, you should spend 15 minutes daily on therapeutic exercises. Exercises shown:

while lying on the mat, make circles with your legs as if riding a bicycle, alternating movements forward and backward;
static exercises for the lower abdominal muscles - while lying down, lift and pull your pelvis towards you, hold in this position for 15–20 seconds, catch your breath and repeat 3 approaches;
shoulder blade stand;
imitate a half-squat position so that the thigh and shin make an angle of 90 degrees, hold for a minute.

Use of medications

Medicines that normalize blood flow can only be prescribed by a doctor after a complete examination. The following medications are used:

Venza is a drug in drops that relieves swelling of tissues and increases the tone of the vascular wall.
Aescusan - tonic drops.
Ascorutin is a complex preparation of ascorbic acid and rutin, has a rejuvenating and antioxidant effect, normalizes cellular metabolism in the area of stagnation, and is a means of preventing inflammation.

Treatment with folk remedies

The following folk recipes are used in treatment to improve pelvic circulation:

a decoction of hawthorn fruits, dried raspberries, rose hips, motherwort, calendula flowers with the addition of orange peel. Brew for half an hour, drink as tea three times a day;
a combination of licorice root, aralia, string, elecampane, rose hips, horsetail in equal quantities, infuse in a thermos overnight, drink ½ glass before meals;
Boil a collection of thyme, calamus root, nettle, buckthorn bark, coltsfoot leaves for 5 minutes in an enamel bowl or brew in a thermos overnight, drink 100 ml three times.

Use herbal preparations at intervals of 2 weeks

When is surgery necessary?

The use of surgical methods is recommended when conservative treatment is ineffective. Most often, operations are performed using endoscopic technology. A laparoscope with a microcamera is inserted through small skin incisions, the organs are inspected, dilated vessels are found and bandaged.

How to prevent stagnation?

Prevention in the pelvic organs includes:

cessation of smoking and excessive consumption of alcoholic beverages and beer;
maintaining an active motor mode, walking, physical exercise, sports;
adhering to reasonable dietary measures regarding the consumption of fatty foods, limiting food processing by frying and sweets;
control over the amount of fluid you drink;
organization of a work regime with provision of rest and warm-up to muscles every 2 hours.

Prerequisites include timely consultation with a doctor and treatment of inflammatory diseases of the genital area, hemorrhoids. This will eliminate unnecessary infectious components and prevent phlebitis and thrombosis of the pelvic veins.

Pelvic inflammatory diseases (PID) are characterized by various manifestations depending on the level of damage and the strength of the inflammatory response. The disease develops when a pathogen (enterococci, bacteroides, chlamydia, mycoplasma, ureaplasma, trichomonas) penetrates into the genital tract and in the presence of favorable conditions for its development and reproduction. These conditions occur during the postpartum or post-abortion period, during menstruation, during various intrauterine manipulations (insertion of an IUD, hysteroscopy, hysterosalpingography, diagnostic curettage).

Existing natural protective mechanisms, such as anatomical features, local immunity, the acidic environment of the vaginal contents, the absence of endocrine disorders or serious extragenital diseases, can in the vast majority of cases prevent the development of genital infection. In response to the invasion of a particular microorganism, an inflammatory response occurs, which, based on the latest concepts of the development of the septic process, is usually called a “systemic inflammatory response.”

Acute endometritis always requires antibacterial therapy. The basal layer of the endometrium is affected by the inflammatory process due to the invasion of specific or nonspecific pathogens. Endometrial protective mechanisms, congenital or acquired, such as T-lymphocyte aggregates and other elements of cellular immunity, are directly related to the action of sex hormones, especially estradiol, act in conjunction with the macrophage population and protect the body from damaging factors. With the onset of menstruation, this barrier on a large surface of the mucous membrane disappears, which makes it possible to become infected. Another source of protection in the uterus is the infiltration of the underlying tissues with polymorphonuclear leukocytes and the rich blood supply of the uterus, which promotes adequate perfusion of the organ with blood and nonspecific humoral protective elements contained in its serum: transferrin, lysozyme, opsonins.

The inflammatory process can spread to the muscle layer: then metroendometritis and metrothrombophlebitis occur with a severe clinical course. The inflammatory reaction is characterized by a disorder of microcirculation in the affected tissues, pronounced exudation; with the addition of anaerobic flora, necrotic destruction of the myometrium can occur.

Clinical manifestations of acute endometritis are characterized already on the 3-4th day after infection by an increase in body temperature, tachycardia, leukocytosis and an increase in ESR. Moderate enlargement of the uterus is accompanied by pain, especially along its ribs (along the blood and lymphatic vessels). Purulent-bloody discharge appears. The acute stage of endometritis lasts 8-10 days and requires quite serious treatment. With proper treatment, the process is completed, less often it turns into subacute and chronic forms, and even less often, with independent and indiscriminate antibiotic therapy, endometritis can take a milder abortive course.

Treatment of acute endometritis, regardless of the severity of its manifestations, begins with antibacterial infusion, desensitizing and restorative therapy.

Antibiotics are best prescribed taking into account the sensitivity of the pathogen to them. The dosage and duration of antibiotic use are determined by the severity of the disease. Due to the frequency of anaerobic infections, additional use of metronidazole is recommended. Considering the very rapid course of endometritis, cephalosporins with aminoglycosides and metronidazole are preferable among antibiotics. For example, cefamandole (or cefuroxime, cefotaxime) 1.0-2.0 g 3-4 times a day IM or IV drip + gentamicin 80 mg 3 times a day IM + Metrogyl 100 ml IV / in drip.

Instead of cephalosporins, you can use semi-synthetic penicillins (for abortive cases), for example, ampicillin 1.0 g 6 times a day. The duration of such combined antibacterial therapy depends on the clinic and laboratory response, but should not be less than 7-10 days. To prevent dysbacteriosis, from the first days of antibiotic treatment, use nystatin 250,000 units 4 times a day or Diflucan 50 mg/day for 1-2 weeks orally or intravenously.

Detoxification infusion therapy may include a number of infusion agents, for example, Ringer-Locke solution - 500 ml, polyionic solution - 400 ml, hemodez (or polydesis) - 400 ml, 5% glucose solution - 500 ml, 1% calcium chloride solution - 200 ml, Unithiol with a 5% solution of ascorbic acid, 5 ml 3 times a day. In the presence of hypoproteinemia, it is advisable to carry out infusions of protein solutions (albumin, protein), blood replacement solutions, plasma, red blood cells or whole blood, and amino acid preparations.

Physiotherapeutic treatment occupies one of the leading places in the treatment of acute endometritis. It not only reduces the inflammatory process in the endometrium, but also stimulates ovarian function. When normalizing the temperature reaction, it is advisable to prescribe low-intensity ultrasound, inductothermy with an HF or UHF electromagnetic field, magnetic therapy, and laser therapy.

Every fifth woman who has suffered salpingo-oophoritis is at risk of infertility. Adnexitis can cause a high risk of ectopic pregnancy and pathological course of pregnancy and childbirth. The fallopian tubes are the first to be affected, and the inflammatory process can involve all layers of the mucous membrane of one or both tubes, but more often only the mucous membrane of the tube is affected, and catarrhal inflammation of the mucous membrane of the tube occurs - endosalpingitis. Inflammatory exudate, accumulating in the tube, often flows through the ampullary opening into the abdominal cavity, adhesions form around the tube and the abdominal opening of the tube closes. A saccular tumor develops in the form of a hydrosalpinx with transparent serous contents or in the form of a pyosalpinx with purulent contents. Subsequently, the serous exudate of the hydrosalpinx resolves as a result of treatment, and the purulent pyosalpinx can perforate into the abdominal cavity. The purulent process can capture and melt increasingly large areas of the pelvis, spreading to all internal genitalia and nearby organs.

Inflammation of the ovaries (oophoritis) As a primary disease, it is rare; infection occurs in the area of the ruptured follicle, since the rest of the ovarian tissue is well protected by the covering germinal epithelium. In the acute stage, swelling and small cell infiltration are observed. Sometimes, in the cavity of the follicle of the corpus luteum or small follicular cysts, ulcers and microabscesses form, which, merging, form an ovarian abscess or pyovarium. In practice, it is impossible to diagnose an isolated inflammatory process in the ovary, and this is not necessary. Currently, only 25-30% of patients with acute adnexitis have a pronounced picture of inflammation; the remaining patients experience a transition to a chronic form, when therapy is stopped after a rapid subsidence of the clinic.

Acute salpingoophoritis It is also treated with antibiotics (preferably third generation fluoroquinolones - Ciprofloxacin, Tarivid, Abaktal), since it is often accompanied by pelvioperitonitis - inflammation of the pelvic peritoneum.

Inflammation of the pelvic peritoneum most often occurs secondary to the penetration of infection into the abdominal cavity from an infected uterus (with endometritis, infected abortion, ascending gonorrhea), from the fallopian tubes, ovaries, from the intestines, with appendicitis, especially with its pelvic location. In this case, an inflammatory reaction of the peritoneum is observed with the formation of serous, serous-purulent or purulent effusion. The condition of patients with pelvioperitonitis remains either satisfactory or moderate. The temperature rises, the pulse quickens, but the function of the cardiovascular system is slightly impaired. With pelvioperitonitis, or local peritonitis, the intestine remains unbloated, palpation of the upper half of the abdominal organs is painless, and symptoms of peritoneal irritation are determined only above the pubis and in the iliac regions. However, patients note severe pain in the lower abdomen, there may be retention of stool and gas, and sometimes vomiting. The level of leukocytes is increased, the formula shifts to the left, the ESR is accelerated. Gradually increasing intoxication worsens the condition of patients.

Treatment of salpingoophoritis with or without pelvioperitonitis begins with a mandatory examination of the patient for flora and sensitivity to antibiotics. The most important thing is to determine the etiology of inflammation. Today, benzylpenicillin is widely used for the treatment of specific gonorrheal process, although drugs such as Rocephin, Cephobid, Fortum are preferable.

The “gold standard” in the treatment of salpingoophoritis from antibacterial therapy is the prescription of Claforan (cefotaxime) at a dose of 1.0-2.0 g 2-4 times a day intramuscularly or one dose of 2.0 g intravenous in combination with gentamicin 80 mg 3 times/day (gentamicin can be administered once at a dose of 160 mg IM). It is imperative to combine these drugs with the administration of Metrogyl IV 100 ml 1-3 times a day. A course of antibiotic treatment should be carried out for at least 5-7 days, prescribing cephalosporins of the second and third generations (Mandol, Zinacef, Rocephin, Cephobid, Fortum and others at a dose of 2-4 g/day).

In case of acute inflammation of the uterine appendages, complicated by pelvioperitonitis, oral administration of antibiotics is possible only after the main course, and only if the need arises. As a rule, there is no such need, and the persistence of previous clinical symptoms may indicate the progression of inflammation and a possible suppurative process.

Detoxification therapy is mainly carried out with crystalloid and detoxification solutions in an amount of 2-2.5 liters with the inclusion of solutions of hemodez, Reopoliglyukin, Ringer-Locke, polyionic solutions - acessol, etc. Antioxidant therapy is carried out with a solution of Unithiol 5.0 ml with a 5% solution of ascorbic acid 3 times/day i.v.

In order to normalize the rheological and coagulation properties of blood and improve microcirculation, acetylsalicylic acid (Aspirin) 0.25 g/day is used for 7-10 days, as well as intravenous administration of Reopoliglucin 200 ml (2-3 times per course). Subsequently, a whole complex of resorption therapy and physiotherapeutic treatment is used (calcium gluconate, autohemotherapy, sodium thiosulfate, Humisol, Plazmol, Aloe, FiBS). Among the physiotherapeutic procedures for acute processes, ultrasound is appropriate, providing analgesic, desensitizing, fibrolytic effects, enhancing metabolic processes and tissue trophism, inductothermy, UHF therapy, magnetic therapy, laser therapy, and later - sanatorium-resort treatment.

Among 20-25% of inpatients with inflammatory diseases of the uterine appendages, 5-9% develop purulent complications requiring surgical interventions.

The following provisions regarding the formation of purulent tubo-ovarian abscesses can be highlighted:

chronic salpingitis in patients with tubo-ovarian abscesses is observed in 100% of cases and precedes them;
the spread of infection occurs predominantly through the intracanalicular route from endometritis (with IUD, abortion, intrauterine interventions) to purulent salpingitis and oophoritis;
frequent combination of cystic transformations in the ovaries with chronic salpingitis;
there is a mandatory combination of ovarian abscesses with exacerbation of purulent salpingitis;
Ovarian abscesses (pyovarium) are formed mainly from cystic formations, often microabscesses merge with each other.

Morphological forms of purulent tubo-ovarian formations:

pyosalpinx - predominant damage to the fallopian tube;
pyovarium - predominant damage to the ovary;
tubo-ovarian tumor.

All other combinations are complications of these processes and can occur:

without perforation;
with perforation of ulcers;
with pelvioperitonitis;
with peritonitis (limited, diffuse, serous, purulent);
with pelvic abscess;
with parametritis (posterior, anterior, lateral);
with secondary lesions of adjacent organs (sigmoiditis, secondary appendicitis, omentitis, interintestinal abscesses with the formation of fistulas).

Clinically differentiating each of these localizations is almost impossible and impractical, since the treatment is fundamentally the same; antibacterial therapy takes a leading place both in the use of the most active antibiotics and in the duration of their use. The basis of purulent processes is the irreversible nature of the inflammatory process. Irreversibility is due to morphological changes, their depth and severity, often accompanying severe renal dysfunction.

Conservative treatment of irreversible changes in the uterine appendages is unpromising, since if it is carried out, it creates the preconditions for the occurrence of new relapses and aggravation of impaired metabolic processes in patients, increases the risk of upcoming surgery in terms of damage to adjacent organs and the inability to perform the required volume of surgery.

Purulent tubo-ovarian formations represent a difficult diagnostic and clinical process. Nevertheless, a number of characteristic syndromes can be identified:

intoxication;
painful;
infectious;
early renal;
hemodynamic disorders;
inflammation of adjacent organs;
metabolic disorders.

Clinically, intoxication syndrome manifests itself in intoxication encephalopathy, headaches, heaviness in the head and severity of the general condition. Dyspeptic disorders (dry mouth, nausea, vomiting), tachycardia, and sometimes hypertension (or hypotension during the onset of septic shock, which is one of its early symptoms along with cyanosis and facial hyperemia against the background of severe pallor) are noted.

Pain syndrome is present in almost all patients and is of an increasing nature, accompanied by a deterioration in general condition and well-being, there is pain during a special examination, displacement behind the cervix and symptoms of irritation of the peritoneum around the palpable formation. Pulsating increasing pain, persistent fever with body temperature above 38°C, tenesmus, loose stools, absence of clear contours of the tumor, lack of effect from treatment - all this indicates the threat of perforation or its presence, which is an absolute indication for urgent surgical treatment . The infectious syndrome is present in all patients, manifested in the majority by high body temperature (38°C and above), tachycardia corresponds to fever, as well as an increase in leukocytosis, ESR and leukocyte index of intoxication increase, the number of lymphocytes decreases, the shift of white blood to the left and the number of molecules of average mass, reflecting increasing intoxication. Often there is a change in kidney function due to impaired urine passage. Metabolic disorders manifest themselves in dysproteinemia, acidosis, electrolyte imbalance, etc.

The treatment strategy for this group of patients is based on organ-preserving principles of surgery, but with radical removal of the main source of infection. Therefore, for each specific patient, the volume of the operation and the time of its implementation should be optimal. Clarifying the diagnosis sometimes takes several days - especially in cases where there is a borderline variant between suppuration and an acute inflammatory process or in differential diagnosis from an oncological process. Antibacterial therapy is required at each stage of treatment.

Preoperative therapy and preparation for surgery include:

antibiotics (use Cefobid 2.0 g/day, Fortum 2.0-4.0 g/day, Reflin 2.0 g/day, Augmentin 1.2 g IV drip 1 time/day, Clindamycin 2.0- 4.0 g/day, etc.). They must be combined with gentamicin 80 mg IM 3 times a day and Metrogyl infusion 100 ml IV 3 times;
detoxification therapy with infusion correction of volemic and metabolic disorders;
mandatory assessment of the effectiveness of treatment based on the dynamics of body temperature, peritoneal symptoms, general condition and blood counts.

The surgical stage also includes ongoing antibacterial therapy. It is especially valuable to administer one daily dose of antibiotics on the operating table immediately after the end of the operation. This concentration is necessary as a barrier to further spread of infection, since penetration into the area of inflammation is no longer prevented by dense purulent capsules of tubo-ovarian abscesses. Betalactam antibiotics (Cephobid, Rocephin, Fortum, Claforan, Tienam, Augmentin) pass these barriers well.

Postoperative therapy includes the continuation of antibacterial therapy with the same antibiotics in combination with antiprotozoal, antimycotic drugs and uroseptics in the future (according to sensitivity). The course of treatment is based on the clinical picture and laboratory data, but should not be less than 7-10 days. Antibiotics are discontinued based on their toxic properties, so gentamicin is often discontinued first, after 5-7 days, or replaced with amikacin.

Infusion therapy should be aimed at combating hypovolemia, intoxication and metabolic disorders. Normalization of gastrointestinal motility is very important (intestinal stimulation, HBOT, hemosorption or plasmapheresis, enzymes, epidural blockade, gastric lavage, etc.). Hepatotropic, restorative, antianemic therapy is combined with immunostimulating therapy (UVR, laser blood irradiation, immunocorrectors).

All patients who have undergone surgery for purulent tubo-ovarian abscesses require post-hospital rehabilitation in order to prevent relapses and restore specific body functions.

Literature

Abramchenko V.V., Kostyuchek D.F., Perfilyeva G.N. Purulent-septic infection in obstetric and gynecological practice. St. Petersburg, 1994. 137 p.
Bashmakova M. A., Korkhov V. V. Antibiotics in obstetrics and perinatology. M., 1996. No. 9. P. 6.
Bondarev N. E. Optimization of diagnosis and treatment of mixed sexually transmitted diseases in gynecological practice: abstract. dis. ...cand. honey. Sci. St. Petersburg, 1997. 20 p.
Ventsela R. P. Nosocomial infections // M., 1990. 656 p.
Gurtovoy B. L., Serov V. N., Makatsaria A. D. Purulent-septic diseases in obstetrics. M., 1981. 256 p.
Keith L.G., Berger G.S., Edelman D.A. Reproductive health: T. 2 // Rare infections. M., 1988. 416 p.
Krasnopolsky V. I., Kulakov V. I. Surgical treatment of inflammatory diseases of the uterine appendages. M., 1984. 234 p.
Korkhov V.V., Safronova M.M. Modern approaches to the treatment of inflammatory diseases of the vulva and vagina. M., 1995. No. 12. P. 7-8.
Kumerle X. P., Brendel K. Clinical pharmacology during pregnancy / ed. X. P. Kumerle, K. Brendel: trans. from English T. 2. M., 1987. 352 p.
Serov V. N., Strizhakov A. N., Markin S. A. Practical obstetrics: a guide for doctors. M., 1989. 512 p.
Serov V.N., Zharov E.V., Makatsaria A.D. Obstetric peritonitis: diagnosis, clinic, treatment. M., 1997. 250 p.
Strizhakov A. N., Podzolkova N. M. Purulent inflammatory diseases of the uterine appendages. M., 1996. 245 p.
Khadzhieva E. D. Peritonitis after cesarean section: a textbook. St. Petersburg, 1997. 28 p.
Sahm D. E. The role of automation and molecular technology in antimicrobial susceptibility testing // Clin. Microb. And Inf. 1997; 3: 2(37-56).
Snuth C. B., Noble V., Bensch R. et al. Bacterial flora of the vagina during the mensternal cycle // Ann. Intern. Med. 1982; p. 948-951.
Tenover F.C. Norel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens // Am. J. Med. 1991; 91, p. 76-81.

V. N. Kuzmin, Doctor of Medical Sciences, Professor
MGMSU, Moscow

Causes of pelvic organ disease

Promiscuous sexual intercourse leading to infection with sexually transmitted diseases:

General fatigue, weakness.

The acute onset of an infectious-inflammatory process is rarely observed. Usually, there is a gradual development of the inflammatory process, without pronounced clinical manifestations, which leads to a chronic form of the disease. Therefore, laboratory and instrumental diagnostic methods are the main ones in determining this group of diseases.

Laboratory and instrumental studies

In the diagnosis of PID, great importance is attached to bacteriological methods and PCR to determine pathogens, their quantity, hysteroscopy and laparoscopy, and pathomorphological examination. All symptoms of pelvic inflammation can be divided into: minimal, additional and reliable criteria.

Minimum clinical criteria:

pain on palpation in the lower abdomen;
pain in the appendage area.
painful sensations when pressing on the cervix.

In the presence of these signs and in the absence of any other cause of the disease, a trial of treatment for PID should be carried out in all sexually active young women of reproductive age.

Additional criteria (to increase the specificity of diagnosis):

Body temperature is above 38.0 degrees.
abnormal discharge from the cervix or vagina
general blood test - leukocytosis, change in leukocyte formula (shift to the left), increased ESR and C-reactive protein content
laboratory confirmation of cervical infection caused by gonococci, trichomonas, chlamydia.

Reliable criteria:

microscopic confirmation of endometritis with endometrial biopsy. This method is carried out using endoscopic equipment, which allows one to penetrate the uterine cavity (carried out through the vagina and cervix) and collect a small section of the endometrium for microscopy.

Thickening of the fallopian tubes, the presence of free fluid in the abdominal cavity according to ultrasound.

Laparoscopic confirmation of the inflammatory local process.

However, it should be noted that it is impossible to make a final diagnosis based only on the results of one of the necessary studies - the examination must be comprehensive.

Treatment

Stages of treatment of inflammatory diseases of the pelvic organs

First - elimination of the provoking factor, since in the presence of a damaging agent, inflammation does not completely eliminate. Therefore, there is no restoration of the anatomical and functional damaged organ (uterus, ovary, fallopian tube).

Second - restoration of the physiological state of the damaged organ and its surrounding organs and elimination of the consequences of secondary damage (restoration of blood circulation, anatomical location, ability to hormonally regulate function).

Non-drug treatment

Traditionally, complex therapy for PID uses physiotherapy, in particular preformed currents. Having a beneficial effect on the local blood circulation of the pelvic organs, regeneration processes, and receptor activity of the endometrium, electrotherapy helps in eliminating the clinical symptoms of the disease and restoring tissue structure.

Drug therapy

Antibacterial therapy

Treatment regimens for PID should address a wide range of possible pathogens. In addition, it is necessary to take into account the possible resistance of microorganisms to traditional antibiotics. Due to the fact that practically no antibiotic is active against all pathogens of PID, their choice in such cases is based on the combined use of drugs in order to ensure coverage of the spectrum of the main (13 including resistant) pathogens. For this purpose, a combination of several antibiotics is used.

Enzyme therapy

Preparations of proteolytic enzymes enhance the effect of antibiotics. One of the representatives of enzyme preparations is Wobenzym, prescribed in conjunction with antibacterial treatment.

Immunomodulatory therapy

You should not rely only on miraculously getting rid of the infection through the use of antibiotics. An important aspect of the treatment of chronic infectious diseases is the stimulation of the body's immune defenses. Immunomodulatory therapy is carried out taking into account the results of an immunological study.

Indications for immunomodulatory therapy:

Long-term course of chronic recurrent inflammatory process.
mixed infections (especially if there is no effect from previous courses of animicrobial treatment).

In order to correct immunity, drugs such as Immunomax, Cycloferon, Lykopid are prescribed.

Metabolism modulation aimed at enhancing tissue metabolism and eliminating the effects of hypoxia. For this purpose, drugs such as Actovegin, E, ascorbic acid, methionine, glutamic acid are prescribed.

Criteria for the effectiveness of treatment– elimination of clinical symptoms of the disease, restoration of the normal structure of the endometrium, destruction or reduction of the activity of the infectious agent, restoration of the morphological structure of the uterus and internal genital organs of the woman. Establishment of regular menstruation and ovulation.

In order to assess the adequacy of therapeutic measures, it is necessary to conduct regular ultrasound monitoring of the dynamics of the process, as well as 2 months after the end of the course of treatment, control morphological and bacteriological examination of the endometrium of the uterus.

Pregnancy prognosis

The success of therapeutic interventions to restore reproductive function depends on the duration of the disease and the severity of structural disorders in the endometrium. After a full course of therapy in the absence of other factors for the development of infertility, the pregnancy rate reaches 80%, but 75% of pregnancies are carried to term.

At birth, a girl's vagina is sterile. Then, within a few days, it is populated by a variety of bacteria, mainly staphylococci, streptococci, and anaerobes (that is, bacteria that do not require oxygen to live). Before the onset of menstruation, the acidity level (pH) of the vagina is close to neutral (7.0). But during puberty, the walls of the vagina thicken (under the influence of estrogen, one of the female sex hormones), the pH decreases to 4.4 (i.e., acidity increases), which causes changes in the vaginal flora. More than 40 types of bacteria can “live” in the vagina of a healthy, non-pregnant woman. The flora of this organ is individual and changes in different phases of the menstrual cycle. Lactobacilli are considered the most beneficial microorganisms of the vaginal flora. They inhibit the growth and reproduction of harmful microbes by producing hydrogen peroxide. The quality of protection they provide in this way exceeds the potential of antibiotics. The importance of normal vaginal flora is so great that doctors talk about it as a microecological system that provides protection to all a woman’s reproductive organs.

There are two main routes of transmission: domestic And sexual. The first is possible if the rules of personal hygiene are not followed. However, more often, infection occurs through sexual intercourse. The most common causative agents of pelvic organ infections are microorganisms such as gonococci, Trichomonas, and chlamydia. However, today it is clear that O Most diseases are caused by so-called microbial associations - that is, combinations of several types of microorganisms with unique biological properties.

Oral and anal sex plays an important role in the spread of infections, during which microorganisms that are not characteristic of these anatomical sections and change the properties of the microecological system, which was mentioned above, enter the man’s urethra and the woman’s vagina. For the same reason, protozoa and worms contribute to infection.

There are some risk factors that make it easier for microbes to “get” to the uterus and appendages. These include:

Any intrauterine interventions, such as the introduction of intrauterine devices, abortion operations;

Multiple sexual partners;

Sex without barrier methods of contraception (birth control pills, etc. do not protect against the transmission of infection, so before conception you must be examined to identify possible infectious diseases of the pelvic organs);

Inflammatory diseases of the female genital organs suffered in the past (there remains a possibility of persistence of a chronic inflammatory process and the development of vaginal dysbiosis - see sidebar);

Childbirth; hypothermia (the well-known expression “the appendages caught a cold” emphasizes the connection between hypothermia and decreased immunity).

DYSBACTERIOSIS OF THE VAGINA

There are so-called vaginal dysbiosis, in which the number of beneficial microbes - lactobacilli - sharply decreases or they disappear altogether. Clinical manifestations of such conditions are often absent, therefore, on the one hand, women are in no hurry to see a doctor, and on the other hand, doctors often have difficulty establishing this diagnosis. Meanwhile, vaginal dysbiosis is associated with a significant number of obstetric and gynecological complications, which will be discussed below. The most common vaginal dysbiosis is:

Bacterial vaginosis. According to research, bacterial vaginosis is found in 21-33% of women, and in 5% of affected women it is asymptomatic. If the doctor made this diagnosis, it means that opportunistic microbes such as gardnerella, ureaplasma, mycoplasma, and enterococcus have entered the woman’s body.

Urogenital candidiasis. Urogenital candidiasis is also a type of vaginal dysbiosis. Its causative agent is the yeast-like fungi Candida. This disease is more common in women than in men. In addition to the vagina, it can spread to the urinary system, external genitalia, and sometimes urogenital candidiasis affects the rectum.

MANIFESTATIONS OF INFLAMMATORY DISEASES OF THE PELVIC ORGANS

Diseases of the female genital organs can be asymptomatic, but in most cases a woman complains of the following:

Pain in the lower abdomen;

Vaginal discharge (their nature depends on the type of pathogen);

Fever and general malaise;

Discomfort when urinating;

Irregular menstruation;

Pain during sexual intercourse.

HOW TO DIAGNOSIS

Making a diagnosis is not an easy task. First, the results of a general blood test are assessed. An increase in the level of leukocytes gives reason to suspect an inflammatory process. Upon examination, the gynecologist may reveal pain in the cervix and ovaries. The doctor also takes vaginal swabs to identify the causative agent of the infection. In difficult cases, they resort to laparoscopy: this is a surgical intervention in which special instruments are inserted into the pelvis through small incisions in the anterior wall of the abdomen, allowing direct examination of the ovaries, fallopian tubes and uterus.

CONSEQUENCES OF PELVIC INFLAMMATORY DISEASES

Before pregnancy. Let's start with the fact that inflammatory diseases of the female genital organs are the most common cause of infertility. The infectious process affects the fallopian tubes, connective tissue grows in them, which leads to their narrowing and, accordingly, partial or complete obstruction. If the tubes are blocked, the sperm cannot reach the egg and fertilize it. With frequently recurring inflammatory processes in the pelvic organs, the likelihood of infertility increases (after a woman has suffered a single pelvic inflammatory disease, the risk of infertility, according to statistics, is 15%; after 2 cases of the disease - 35%; after 3 or more cases - 55%).

In addition, women who have had pelvic inflammatory disease are much more likely to develop an ectopic pregnancy. This occurs because the fertilized egg cannot travel through the damaged tube and enter the uterus for implantation. Laparoscopic restoration of fallopian tube patency is often used for tubal infertility. In difficult cases, in vitro fertilization is resorted to.

Pregnancy. If, nevertheless, pregnancy occurs against the background of an already existing inflammatory process in the pelvic organs, then it should be borne in mind that due to a completely natural decrease in the activity of the immune system during pregnancy, the infection will certainly “raise its head” and its aggravation will occur. Signs of exacerbation that force a woman to see a doctor depend on the type of causative agent of a particular infection. Abdominal pain and vaginal discharge (leucorrhoea) are almost always a concern. In such a situation, the pregnant woman and the doctor will have to solve a difficult question: what to do with the pregnancy. The fact is that exacerbation of the inflammatory process is fraught with the threat of termination of pregnancy; such a pregnancy is always difficult to maintain. In addition, the required antibacterial treatment is not indifferent to the developing fetus. If the infection is caused by pathogenic microorganisms, especially those related to sexually transmitted diseases (syphilis, gonorrhea), the doctor often recommends termination of pregnancy. If there is dysbacteriosis and a situation where opportunistic microorganisms have taken the place of the natural inhabitants of the female genital organs (see sidebar), the doctor will select treatment based on the sensitivity of the detected pathogens to antibiotics and the duration of pregnancy.

The situation deserves special mention when during pregnancy there is not an exacerbation of an existing inflammatory process, but infection and subsequent development of the infection. This is often accompanied by the penetration of an infectious agent into the fetus and intrauterine infection of the latter. Now doctors can trace the development of the pathological process in the fetus; the decision on the necessary measures is made depending on the characteristics of each specific case.

A persistent (untreated or undertreated) infectious process affecting the birth canal (i.e., the cervix, vagina and external genitalia) is fraught with infection of the child during childbirth, when a healthy baby, having successfully avoided intrauterine contact with infection thanks to the protection of the membranes, becomes completely defenseless. In such cases, doctors often insist on a caesarean section.

Now it becomes clear why even healthy women must undergo examination twice during pregnancy to detect infectious diseases of the reproductive organs (a vaginal smear examination, and, if necessary, a blood test for the presence of antibodies to certain pathogens). And of course, existing diseases should be cured.

TREATMENT

Treatment tactics and medications are selected only by a doctor. During pregnancy, there are certain restrictions regarding the use of antibiotics, antivirals and some other drugs. You should definitely find out all this at a doctor's appointment. Naturally, the best option is a planned pregnancy, before which you and your partner undergo all the necessary examinations and, if a disease is detected, receive treatment.

Various antibiotics are used to treat pelvic inflammatory diseases. After completion of treatment, a control smear is taken from the woman’s vagina to assess the effectiveness of therapy. During treatment, it is not recommended to be sexually active. When continuing sexual intercourse, a man must use a condom. At the same time, the woman’s sexual partner (or sexual partners) is treated, otherwise there is a high risk of re-infection. In difficult cases, the patient is hospitalized. In the clinic, as a rule, they begin to administer antibiotics intravenously, then move on to oral administration. It happens (in about 15% of cases) that the initially prescribed antibacterial therapy does not help, then the antibiotic is changed. 20-25% of women of reproductive age have relapses of the disease, so a woman who has suffered such a disease must change her life in such a way as to minimize the risk of recurrent diseases.

Inflammatory diseases of the pelvic organs are a group of pathologies associated with infection of the genital organs, which can subsequently lead to infertility. It is inflammatory diseases of the pelvic organs that cause ectopic pregnancy.

Diseases of the pelvic organs are most often diagnosed in adolescence during puberty.

Causes of pelvic inflammatory diseases

Most often, inflammatory diseases of the pelvic organs occur due to infection. Normally, the cervix has a protective function and does not allow infection to enter the uterine cavity. As a result of any violations, for example with gonorrhea, the cervix loses its abilities, and the pathogen penetrates into deeply located organs.

In addition, inflammatory diseases of the pelvic organs can occur as a result of surgery, instrumental examinations, as complications after childbirth or abortion, and so on.

Symptoms of pelvic inflammatory diseases

Depending on which organ is affected, certain symptoms may occur. But it is still possible to identify those that patients most often present during a visit to a specialist. This is primarily pain. It can be pulling, sharp or sharp. In addition, discharge of various types is characteristic. The menstrual cycle is most often disrupted, and urination is painful. As the disease progresses, the temperature rises, nausea and vomiting appear.

It should be especially noted that women with chronic infections, an active sexual life, as well as those who already have a history of inflammatory diseases of the pelvic organs are susceptible to pathology.

Diagnosis of inflammatory diseases of the pelvic organs

To make a diagnosis, you should visit a gynecologist and undergo a full examination. First of all, an inspection is carried out. Based on this, the course of further actions is determined. During the examination, tests for infections are taken.

Next, an ultrasound examination or sonogram is prescribed. In some cases, a tissue biopsy may be required to confirm the diagnosis. Laparoscopy is especially indicative, allowing one to assess the condition of internal organs using a visual examination.

Treatment of inflammatory diseases of the pelvic organs

When treating inflammatory diseases of the pelvic organs, antibiotics are first prescribed. In this case, it is very important to determine the nature of the infection and its causative agent, which allows you to select the most effective drug. It should also be noted that treatment is often carried out for both partners, since the cause of the disease may be a sexually transmitted infection.

In some cases, surgery may be required. Most often, this situation occurs in the presence of abscess formation. In this case, the operation can be performed either open or endoscopic. Of course, the second one is more profitable, since it allows manipulation with a minimum of blood loss. In addition, the rehabilitation period is significantly reduced.

If left untreated, the risk of developing conditions that cause infertility, such as adhesions in the fallopian tubes, increases.

Prevention of inflammatory diseases of the pelvic organs

In order to avoid inflammatory diseases, you should maintain genital hygiene. The use of personal protective equipment, treatment of sexually transmitted diseases, and pathologies of neighboring organs will eliminate the risk of complications.

So, what is PID? In a broad sense, these are inflammatory processes of the uterus, ovaries and fallopian tubes related to the female genital organs. As a complication of such inflammation, this is primarily the adhesive process of the pelvic organs (fibrous cords of connective tissue between tissues and organs or adhesions).

Symptoms and signs of pelvic inflammation:

Let's define what a “symptom” is?

This is, first of all, the patient’s feeling, and a “sign” is an expression of the disease, which is determined by the doctor. As an example, a rash is a sign, and pain is a symptom.

In most women, inflammatory processes of the pelvic organs occur without any symptoms, and the patient does not find out about her problem immediately, but, for example, when she comes for an examination for the purpose of a preventive examination, or to identify the causes of infertility.

pain in the abdomen and/or lumbar region, can even be very pronounced, patients often take antispasmodics and painkillers, which radiate to the groin of the abdomen, leg, rectum;
painful sensations and severe pain during sexual intercourse,
increased body temperature (not always);
general fatigue, weakness, tiredness, decreased performance;
menstrual irregularities, irregular menstruation;
unusual vaginal discharge, genital itching;
the appearance of ulcers, blisters, condylomas or spots near the entrance to the vagina, the anus, on the vulva;
frequent, painful, sometimes painful urination;
nausea, vomiting (intermittent);
absence of pregnancy.

The most common causes of PID:

So we found out that, as a rule, PID is caused by infection. The infection, entering the vagina, ascends to the cervix and can infect the fallopian tubes and even the ovaries. It is often a mixed infection and is caused by several types of viruses and/or bacteria. – the most common cause of inflammation (50-65%), gonorrheal infection is no less dangerous (14% of cases).

Abortion, miscarriage and childbirth. During childbirth or in the early postpartum period, during surgery to terminate pregnancy and curettage of the uterine cavity, bacteria/viruses enter the vagina; then they actively multiply, and due to incomplete closure of the cervix, they cause inflammatory complications.

Complications of PID:

abscesses of the ovaries, fallopian tubes, vulva area, vaginal opening;
(atypical location of embryo development outside the uterus, usually in the fallopian tubes);
and the worst thing is that approximately 20% of women with inflammatory diseases of the pelvic organs face the problem of getting pregnant due to adhesions in the fallopian tubes and their obstruction.

Diagnosis of inflammatory processes of the pelvic organs:

At the appointment, the attending physician asks the patient questions regarding the symptoms of the disease and conducts a gynecological examination.

During the examination, the doctor usually takes a smear from the cervix, vagina and urethra for microflora and prescribes. The patient may also be prescribed general and. However, smears and other tests do not always reveal an infection, then an ultrasound of the pelvic organs is prescribed to determine inflammation of the fallopian tubes. But we must remember that ultrasound can only show severe inflammation.

Methods for treating pelvic inflammatory disease

We all understand that the sooner we start treatment, the less likely there are serious complications, especially such as infertility.

The first priority in the treatment of PID is the prescription of antibacterial agents.

Typically, the duration of taking antibiotics lasts on average 7-10 days. Patients with pain or other severe symptoms are admitted to the hospital.

Of course, surgical operations such as salpingectomy (removal of one or both fallopian tubes) are widely used and can be performed for abscesses or obstruction of the fallopian tubes. Doctors always try to avoid removing both fallopian tubes at once, since such a tactic will lead to the woman’s inability to become pregnant on her own.

In such circumstances, the sexual partner should also be examined and simultaneously treated for the infection, since if the partner is infected, there is already a 100% risk of re-inflammation in the woman.

Both sexual partners should definitely abstain from sexual intercourse until the end of treatment.

Prevention of PID

Use barrier contraception - condoms.
Get regular examinations from a gynecologist, especially if you change several sexual partners.
The need for regular examination of the sexual partner.
Abstinence from sexual intercourse until the cervix is completely closed (at least a month) after childbirth, abortion or miscarriage.

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