Abordagem atual da doença inflamatória pélvica / Current approaches to pelvic inflammatory disease

A doença inflamatória pélvica (DIP) é um processo inflamatório de natureza infecciosa que pode atingir estruturas e órgãos do trato genital superior. Devido à sua importância epidemiológica e de suas graves complicações, este artigo atualiza e propõe uma abordagem sistemática da DIP. Os principais agentes etiológicos são a Neisseria gonorrhoeae,Chlamydia trachomatis e outros agentes etiológicos de uretrites, cervicites, vulvovaginites e vaginoses, em geral, polimicrobiana, o que é a base de sua terapêutica. A mulher deve ser investigada para DIP quando apresenta, especialmente, desconforto abdominal, dor lombar, dispareunia e nódoas ou manchas ao exame ginecológico, previamente a procedimentos transcervicais. A classificação clínico-laparoscópica deDIP pode ser dividida em: a) estágio I (endometrite/salpingite sem peritonite); estágio II (salpingite aguda com peritonite); estágio III (salpingite aguda com oclusão tubária ou abscesso tubo-ovariano); estágio IV (abscesso tubo-ovariano roto). A definição do estágio orienta a conduta e o tratamento, pois em formas leves (estágio I) o tratamento e seguimento podem ser feitos ambulatorialmente, enquanto para os casos moderadosou graves a internação hospitalar está indicada para início do tratamento por via endovenosa e monitorização da resposta ao tratamento. O tratamento suportivo, retirada de dispositivo intrauterino (DIU), abstinência sexual e repouso também são indicados, além de orientações sobre as implicações da doença e abordagem do parceiro.

Pelvic inflammatory disease (PID) is an inflammatory process of infectious nature that can affect structures and organs of the upper genital tract. Considering this disease's epidemiological relevance and severe complications, this article provides an update and proposes a systematic approach to PID. The main etiological agents are Neisseria gonorrhoeae, Chlamydia trachomatis and other etiological agents of urethritis, cervicitis, vulvovaginitis and vaginoses. These are generally of polymicrobial origin, which determines the treatment basis for pelvic inflammatory diseases.Women must be checked for PID when experiencing abdominal discomfort, backache, dyspareunia, or presenting with stains during gynecological examination and prior to transcervical procedures. The clinical and laparoscopic classification of PID can be divided into: a) stage I (endometritis/salpingitis without peritonitis), stage II (acute salpingitis with peritonitis), stage III (acute salpingitis with tubal occlusion or tube-ovarian abscess), and stage IV (tube-ovarian abscess rupture). Defining the stage guides procedures and treatment, given that in mild forms (stage I) the treatment and follow-up can be performed in the ambulatory environment while moderate to severe cases require hospitalization so that intravenous treatment and treatment outcome monitoring can be started. Supportive treatment, removal of intrauterine device (IUD), sexual abstinence and rest are also indicated, as well as counseling on the implications of the disease and partner approach.

Intervención educativa para la reducción de la morbilidad por enfermedad inflamatoria pélvica en adolescentes / Educational intervention to reduce morbidity from pelvic inflammatory disease in adolescents

Introducción: La enfermedad inflamatoria pélvica es considerada en la actualidad como un problema de salud pública mundial sobre todo por la alta incidencia que tiene en la población juvenil. Objetivo: evaluar los resultados de la intervención educativa dirigida a las adolescentes con síntomas sugestivos de enfermedad inflamatoria pélvica hospitalizadas en el Servicio de Ginecología. Método: se realizó un estudio de intervención pre-experimental con una muestra intencional de las adolescentes que fueron ingresadas en el Hospital Universitario Gineco-Obstétrico Mariana Grajales...

Enfermedad inflamatoria pélvica y adolescencia / Pelvis inflammatory disease and the adolescence

Se conoce como enfermedad inflamatoria pélvica (EIP) a la infección del tracto genital superior, incluye las distintas fases evolutivas del proceso infeccioso, así como la participación de cualquiera de sus localizaciones, la inflamación de las trompas de Falopio es la forma más común. Esta entidad puede aparecer en cualquier momento de la vida reproductiva de la mujer, pero es mucho más alto el riesgo de aparición durante la adolescencia y juventud, se acepta que en las menores de 20 años este llega a ser 3 veces mayor que en el grupo de 25 a 29 años. La mayor frecuencia de esta enfermedad en adolescentes y jóvenes se explica, entre otras cosas, por la estrecha asociación existente entre las infecciones de transmisión sexual (ITS) y la EIP, hoy día se considera que en más del 90 por ciento de todas las EIP se encuentra presente un episodio reciente de ITS. Como es ampliamente conocido, la práctica de conductas sexuales de riesgo es una característica común en estas edades, lo que hace que este sector de la población está sometido a un riesgo más elevado de ITS, EIP y sus secuelas. En la presente revisión intentamos abordar la problemática de la EIP en las adolescentes, con una visión integral y con la actualidad que amerita el tema, convencidos de la importancia de su prevención, así como de su correcto diagnóstico y manejo, con vistas a promover y proteger la salud sexual y reproductiva de este vital sector de la población

The pelvis inflammatory disease (PID) is known as the infection of the superior genital tract including the different evolutionary phases of the infectious process, as well as the involvement of any of its locations, the inflammation of the Fallopian tubes is the commonest way. This entity may to appear in any moment during the reproductive life of woman, but it is much higher the risk of appearance during adolescence and youth accepting that in those aged of 20 it is three times greater than the group aged of 25-29. The great frequency of this disease in adolescents and young peoples is explained among other things, by the close association between the sexual transmited desease (STD) and the PID; nowadays it is considered that in more than 90 percent of all the PIDs is present a recent episode of STD. As it is fully known, the practice of risky sexual behaviors is a common feature in these ages thus this sector of population is in a higher risk of STD, PID and its sequelae. In present review we try to approach the problem of PDI in adolescents with an integral overview and also with the update that this subject need, as well as its proper diagnosis and management to promote and to protect the sexual and reproductive health of this important population sector

Abused women and risk for pelvic inflammatory disease.

Mexican and African American women with sexually transmitted diseases (STDs) underwent targeted physical exams and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms affecting diagnoses of STDs and risk for PID. Bivariate comparisons found abused women reported more PID risk behaviors including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found abused women were more likely to report pathologic genitourinary symptomatology than nonabused women. Clinicians made more presumptive diagnoses of PID for abused than for nonabused women upon physical examination. These findings indicate abused women are at high risk for PID. Its considerable impact on genitourinary symptomatology and risk for PID make assessment for abuse essential in clinical management of women with STDs and diagnosis of PID.

¿Son los dispositivos intrauterinos y el inicio de las relaciones sexuales factores de riesgo y los anticonceptivos orales factor protector para la enfermedad inflamatoria pélvica?: (estudio de casos y controles) / Are the intrauterine devices and the begin of the sexuals relations risk factors and the contraceptives orals protecting factor to the inflamatory pelvic disease?: (study of case and controls)

Evaluar la asociación entre uso de DIU, ACO e incio de las relaciones sexuales con EIP. Estudio de casos y controles de historias de pacientes hospitalizadas en (Ginecología, Hospital Universitario de Caracas (1987-1993). Fueron estudiadas 184 mujeres (15-45 años), activas sexualmente; 92 casos y 92 controles. Se estimó el riesgo relativo, intervalos de confianza al 95 por ciento y la prueba estadística X². Comparando usaurias DIU con no usuarias se encontró un riesgo estimado de 4,5, estadísticamente significante (X² 13,13;IC 95 por ciento) 2,01-10,00). Los ACO tuvieron riesgo estimado de 0,8 (X² 0,55;IC 95 por ciento 0,36-1,74), estadísticamente no significante. Se encontró asociación causal entre la actividad sexual y EIP, con riesgo estimado de 1,7(X² 2;6;IC 95 por ciento 0,84 3,71) estadísticamente no significante. El DIU es el único factor de riesgo significantemente comprobado este estudio

Prevención de la infección pélvica posterior a la aspiración manual endouterina / Prevention of pelvic infection following endouterine manual suction

El propósito de este estudio fue evaluar la eficacia del metronidazol o la tetraciclina en la prevención de la infección pélvica (IP) en las pacientes con aborto incompleto no complicado, las cuales fueron sometidas a la aspiración manual endouterina en forma ambulatoria. El estudio se realizó desde enero hasta junio de 1997; en este período 95 pacientes elegibles fueron aleatoriamente asignadas en tres grupos de estudios; 33 pacientes recibieron metronidazol, 28 pacientes tetraciclina y 34 pacientes placebo, durante 7 días. Luego fueron evaluadas al décimo día y al mes post AMEU. Del total de pacientes, 10 (10,5 por ciento) desarrollaron IP post AMEU. hubo infecciones para el metronidazol 2/33 (6,0 por ciento), tetraciclina 2/28 (7,1 por ciento) y para el grupo placebo 6/34 /17,6 por ciento), de ellos dos requirieron hospitalización: Concluimos que el tratamiento antibiótico post AMEU con metronidazol o tetraciclina reduce considerablemente la infección, significativamente en sus formas graves. Palabras clave: Infección pélvica, prevención, aspiración endouterina.

Efeito da heparina na prevençäo de aderências pélvicas: estudo experimental / Heparin effect in prevention of pelvic adhesions: experimental study

Trinta e uma cadelas SRD foram submetidas a lesäo padronizada sobre o corno uterino D, que consiste em esmagamento, escoriaçäo e isquemia do segmento lesado. Três grupos de estudo foram formados: 1§) grupo controle (GC); 2§) grupo experimental 1 (G1); e 3§) grupo experimental 2 (G2). No GC, usamos lavagem contínua com soluçäo de ringer simples durante o ato cirúrgico. No G1, adicionamos heparina à soluçäo de ringer, na dose de 100UI/kg. No G2, além da adiçäo da heparina deluída em ringer, administramos heparina subcutânea de 12/12h, durante três dias, na dose de 100UI/kg/dose. Determinamos o percentual de cäes que apresentaram aderências na pelve e incisäo laparotômica. Graduamos a intensidade das aderências na incisäo e pelve. Cem por cento dos cäes do G2 apresentaram aderências na incisäo, contra 66,66% dos GC. Näo houve diferença estatística. Todos os grupos apresentaram aderências na pelve em torno de 50%. A intensidade das aderências na pelve näo foi diferente nos três grupos, mas o G2 apresentou índice de aderências maior do que o GC, sendo essa diferença significativa estatisticamente

[Heparin effect on prevention of pelvic adhesions. Experimental study]. / Efeito da heparina na prevenção de aderências pélvicas. Estudo experimental.

Thirty-one mongrel female dogs were submitted to a standard lesion on the right uterine horn, consisting of crushing, scratching, and ischemia of the segment. Three groups were formed for the study: control group (GC), experimental group I (G1), and experimental group II (G2). In GC, continuous washing with simple ringer solution was applied during surgery. In G1, heparin was added to the ringer solution at a doses of 100 IU/kg. In G2, in addition to the heparin diluted in the ringer solution, subcutaneous heparin was given at 12 hours intervals for three days, at a doses of 100 IU/kg/doses. The percentage of dogs with pelvic adhesions was determined by laparotomy. Adhesion intensity in the incision and in the pelvis was determined. 100% of dogs in G2 had adhesions in the incision, whereas 66.66% had incision adhesion in GC. There was no statistical difference. All groups presented around 50% of pelvic adhesions. Intensity of pelvic adhesions was not different in the three groups, but G2 had more adhesions than GC, such difference being statistically significant.

Problems and proposals for the surveillance and control of sexually transmitted diseases associated with pelvic inflammatory disease in South America.

In South America, the number of women at risk for gonococcal pelvic inflammatory disease has increased greatly along with the incidence rates for gonorrhea. Further information is needed on the epidemiologic aspects of gonorrhea and PID in order to develop programs for optimal control of sexually transmitted disease (STD). We think that the control of STD, including PID, requires improvement of four basic factors: professional training in STD, management of STD by all levels of health care services, laboratory diagnostic services, and public education in STD.

PIP: The number of women at risk for gonococcal pelvic inflammatory disease has increased greatly in South America as has the incidence rates for gonorrhea. IN an effort to summarize the problems encountered in the control of sexually transmitted disease (STD) agents associated with pelvic inflammatory disease (PID), official documents prepared for the Pan American Health Organization and articles published in South American journals were reviewed. The problem of PID essentially involves fertile women between the ages of 15 and 49 years. Fertile women are at greater risk for STD, and the number of such women has increased markedly. Between 1970 and 1975, the reported incidence rates of gonoccal infection increased 29% in Bolivia, 25% in Uruguay, 15% in Argentina, and 13% in Colombia. The rates in Paraguay declined by 50%. Surveillance systems for STD are inaccurate in South American countries, and the health care services offer highly variable population coverage. In most South American countries, programs for the control of STD are limited to the control of prostitution and evaluation and treatment of prostitutes, prenatal serologic screening for syphilis, and studies performed in women attending hospital gynecology clinics. The other factors contributing to poor STD control are: the medical care system; medical care coverage; professional STD training; laboratory system; antibiotic misuse; and public education. Ignorance regarding STD on the part of physicians works as a major barrier to more effective control programs. It is essential that clinical services for STDs be available for the majority of a country's population.