Is intrauterine device a risk factor for failure of conservative management in patients with tubo-ovarian abscess? An observational retrospective study

Abstract

Tubo-ovarian abscess (TOA) is a serious and potentially life-threatening complication of pelvic inflammatory disease (PID). TOA formation may be an uncommon, but serious complication associated with the use of an intrauterine device (IUD). While the majority of TOA respond to antibiotic therapy, in approximately 25% of cases surgery or drainage is indicated. In the present study, we compared the failure rate of conservative management in patients with and without IUD, who were admitted with a diagnosis of TOA. In this retrospective case-control study, 78 women were diagnosed with TOA. All patients were treated initially by broad-spectrum intravenous antibiotics. The failure of conservative management after 72h was followed by surgical intervention. The patients were divided into two groups: 24 patients were IUD-carriers, and 54 did not use IUD. There was no significant difference in surgical intervention rate between IUD group (50%) and no-IUD group (43%), p=0.32. The WBC count was significantly higher in IUD-carriers diagnosed with TOA than in patients without IUD (16.5±6.6 vs. 13.1±4.6, p=0.001). The patients with IUD had significantly larger abscesses as revealed by ultrasound than patients without IUD (61.6±21.4 vs. 49.6±20.6mm, p=0.02). The surgical intervention rate in TOA patients with and without IUD was similar.