Tubo-Ovarian Abscess in Early Pregnancy - Report of a Rare Coexistence

AS Portela-Carvalho,C Estevinho,P Brandão,A Melo,E Soares

doi:10.23937/2377-9004/1410115

Abstract

Pelvic inflammatory disease is extremely rare during pregnancy. Both differential diagnosis and management of tubo-ovarian abscesses in pregnancy are challenging and associated with poor obstetric outcomes. The authors present a case of a 17-years-old girl with low abdominal pain for five days. A tubo-ovarian abscess was suspected, with an early pregnancy of unknown location.

Highlights

Pelvic Inflammatory Disease (PID) is an inflammatory and infectious disorder of the female upper genital tract
When there is no clinical improvement or in complicated cases, inpatient treatment with intravenous antibiotics is recommended with Cefoxitin 2 g IV every 6 hours and Doxycycline 100 mg per os (PO) twice a day or Clindamycin 900 mg IV every 8 hours with Gentamicin 1.5 mg/Kg IV every 8 hours followed by 14 days of Doxycycline 100 mg PO twice a day or Clindamycin 450 mg PO every 6 hours [2,6]
Pelvic inflammatory disease may appear in pregnant patients and it is associated with poor obstetric outcomes

Summary

Introduction

Pelvic Inflammatory Disease (PID) is an inflammatory and infectious disorder of the female upper genital tract. If there is an inflammatory status with hyperthermia, vaginal discharge, cervical tenderness and large heterogeneous adnexal masses, it is suggestive of PID. 48 hours after admission there was a slight clinical recovery, serum analysis revealed improvement of the inflammatory parameters (Leucocytes: 11.3 × 103/uL; CRP: 42.7 mg/L) and increase in beta hCG (312 mUI/mL), compatible with normal evolution of an intrauterine pregnancy. The patient status kept on slowly but progressively improving and beta hCG levels suggested intrauterine viable pregnancy She completed 14 days of intravenous antibiotics. After confirming the uterine cavity was empty and the blood loss was controlled, the patient was discharged and medicated with 200 mg of Doxycycline PO She was sent to our Gynaecology outpatient clinic to complete follow-up of the adnexal pathology but missed the appointments once again

Discussion

Conclusion