Cervical Motion Tenderness Research Articles

Tubo-Ovarian ectopic pregnancy: a rare twin ectopic pregnancy

The most common twin ectopic pregnancy is heterotopic (1/7000). We are reporting a rare case of twin tubo-ovarian ectopic pregnancy, which was presented in the emergency department of Ayub Teaching Hospital Abbottabad. A 30-year-old female arrived with worsening lower Abdominal pain persisting for three weeks. She also had per-vaginal bleeding with passage of clots 1week ago. Clinical examination revealed a tense abdomen with tenderness in the left iliac fossa. Per-vaginally, there was cervical motion tenderness and fullness in the posterior fornix. Beta HCG level revealed a sub-optimal rise whereas Transabdominal ultrasound showed an echogenic shadow in the left ovary. The uterus appeared normal. On exploratory laparotomy a large left ovarian mass was seen with ruptured chronic right tubal pregnancy with adhesions. On cut-section of the ovary, a small foetus was evident. ---Continue

Signs and symptoms of serious illness in adults with acute abdominal pain presenting to ambulatory care: a systematic review.

Acute abdominal pain is a common complaint, caused by a variety of conditions, ranging from acutely life-threatening to benign and self-limiting, with symptom overlap complicating diagnosis. Signs and symptoms may be valuable when assessing a patient to guide clinical work. Summarising evidence on the accuracy of signs and symptoms for diagnosing serious illness in adults with acute abdominal pain in an ambulatory care setting. We performed a systematic review, searching for prospective diagnostic accuracy studies that included adults presenting with acute abdominal pain to an ambulatory care setting. Six databases and guideline registers were searched, using a comprehensive search strategy. We assessed the risk of bias, and calculated descriptive statistics and measures of diagnostic accuracy. Results were pooled when at least four studies were available. Out of 18 923 unique studies, 16 studies with moderate to high-risk bias were included. Fourteen clinical features met our criteria, including systolic blood pressure <100 mmHg (positive likelihood ratio [LR+]7.01), shock index >0.85, uterine cervical motion tenderness (LR+5.62 and negative likelihood ratio [LR-]8.60), and a self-assessment questionnaire score >70 (LR+12.20) or <25 (LR-0.19). Clinical diagnosis made by the clinician had the best rule-in ability (LR+24.6). We identified 14 signs and symptoms that can influence the likelihood of a serious illness, including pain characteristics, systemic signs, gynaecological signs, and clinician's overall assessment. The risk of bias was moderate to high, leading to uncertainty and preventing us from making firm conclusions. This highlights the need for better research in this setting.

Characteristics of Acute Pelvic Inflammatory Disease in Surgically Treated Females Over Ten Years - A Single-Center Study

Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital „ Sveti Duh“ between 2009 and 2019. Results: Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (P=0.017) and absent between 15-24 (P=0.012) and 25-34 years (P=0.049). The length of hospital stay was influenced by the number of symptoms (ρ=0.316, P=0.002), admission CRP levels (ρ=0.620, P&lt;0.001), and admission body temperature (ρ=0.386, P&lt;0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (P=0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Conclusion: Severe clinical picture that requires surgical treatment can be expected in women &gt;35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.

A Cross-sectional Observational Study of the Etio-pathology, Socioeconomic Distribution and Clinical Pictures of Ectopic Pregnancy in a Tertiary Medical College and Hospital in Bankura, West Bengal, India

Background: Ectopic pregnancy or abnormal implantation of embryo is one of the foremost causes of mortality and morbidity in women of reproductive age worldwide. Its serious consequences can be effectively averted by early diagnosis and timely intervention. This study aimed at determining the incidence, predisposing socio-economic factors and etiolo-pathology, and assessment of various clinical manifestations and treatment modalities of ectopic pregnancy. Methods: This observational cross- sectional survey was conducted in the department of obstetrics and gynaecology BSMCH, Bankura from 1.4.2015 to 31.3.2016. It included 100 patients with admitted with clinically or sonologically confirmed ectopic pregnancy after informed consent, data was collected and analysed thereafter. Results: It was observed that 68% of the cases belonged to 21-30 years of age, 80% with low socio-economic status, 69 % comprised of multigravidas. The typical risk factors detected were history of PID, abortion and previous tubal surgery. The most consistent clinical feature was pain in lower abdomen (98%) followed by amenorrhoea (90%) and vaginal bleeding (82%). 97% of the patients presented with pallor and 23% with shock. In 73% patients cervical motion tenderness could be elicited clinically and adnexal mass in USG was found in 95 %. Urine pregnancy test was positive in all patients and right side was the commonest side of involvement (53%). All the patients underwent surgical intervention. Conclusion: Prompt detection from history, clinical features, USG and appropriate and well-timed management are of utmost importance to enhance better maternal survival and conservation of reproductive capacity. Keywords: Ectopic pregnancy, UPT, PID, Tubal surgery, Adnexal mass, POD fluid, Ampulla

Medical management/Non-surgical of ectopic pregnancy: Case report and review of literature

Ectopic pregnancy is a cause of maternal morbidity and mortality. Management options are surgical, medical and expectant management. Medical management also known as the non-surgical approach is not widely practiced in our environment despite its several advantages over the traditional open salpingectomy including its less invasiveness, reduced cost and absence of anaesthetic risk, surgical risk and need for hospital admission. It however requires early presentation and diagnosis before tubal rupture, a well motivated patient and fulfilment of strict criteria in well selected patients. Aim. To present this rare case report of the medical/non-surgical management of unruptured ectopic pregnancy and a review of the literature. Case report: Mrs AW, Para 3+0 (2 alive) who presented with lower abdominal pains and abnormal scanty vaginal bleeding following 6 weeks of amenorrhoea. Her physical examination revealed a stable cardiovascular state. There were no significant abdominal findings. Vaginal examination revealed positive cervical motion tenderness. A diagnosis unruptured ectopic pregnancy was made. Pelvic ultrasound scan revealed a cystic left adnexial mass measuring 1.94 cm by 1.7 cm with thickened, well circumscribed margins and it contained an echogenic mass (fetal pole) with cardiac pulsation (145/min). The crown-rump length was 0.76cm which corresponded to 6 weeks plus 5 days of gestation. Her serum β hCG was 3625.8miu/ml. She expressed her aversion for a surgical intervention having had 3 previous surgeries. She gave an informed consent for medical/non-surgical management with intramuscular Methotrexate. She subsequently received 3 doses of weekly 100mg intramuscular methotrexate. Each dose of Methotrexate was preceded by re-evaluation of liver/renal function test, full blood count and serum β hCG. By the 4th week of treatment the success of her treatment was confirmed by the insignificant level of β hCG and findings at TVS. She was counselled on the need for prompt localization of any subsequent pregnancy. Conclusion: We presented Mrs AW who was successfully managed for unruptured ectopic pregnancy using the medical/non-surgical approach on out-patient basis. Proper patient selection and follow-up is required for a favourable outcome,

AN ESSENTIAL TOOL TO BE OPTIMIZED: SYNDROMIC MANAGEMENT OF VAGINAL DISCHARGE IN HAITI.

Haiti, like many low-income countries in crisis, has limited resources for etiologic diagnosis of vaginal discharge. As such, we sought to characterize variability in diagnoses of women presenting with vaginal discharge syndrome, with the goal to improve standardization of syndromic management. Participants aged 18 years and older endorsing vaginitis, or dysuria were recruited at Jerusalem Clinic over two, one-week periods in April 2018 and July 2019. We calculated Spearman rank correlations among history, exam findings, and diagnoses based on clinical presentation, to understand presentation groupings and their management. Among 98 women, median age was 33.5 years, and most frequent symptoms were: vaginal discharge (97%), vaginal itch (73%), and/or suprapubic pain (68%). Most common physical exam findings were vaginal discharge (86%), suprapubic/lower quadrant tenderness (29%), cervical motion tenderness (24%), and cervical erythema (20%). Most symptoms and physical exam findings were weakly correlated with each other. Nearly one-third (31%) were diagnosed with normal physiologic vaginal discharge or no diagnosis, followed by Bacterial vaginosis (31%), vulvovaginal candidiasis (15%), cervicitis/PID (13%), and STI (7%). No reported symptoms strongly differentiated diagnostic categories. Diagnoses varied considerably by exam findings. The weak correlations between symptoms, exam findings, and diagnoses could represent variability in assessment. In the absence of reliable and accessible laboratory testing, the importance of standardizing syndromic management becomes increasingly relevant. Results from our study support the utility of speculum examination and more standardized documentation of physical exam findings. Next steps include the development of local algorithms to promote standardization of treatment of vaginal discharge syndrome.

Not every twist is ovarian torsion: a case report of isolated torsion of the fallopian tube in a child.

A 15-year-old girl presented with complaints of sudden onset left lower quadrant pain, nausea, and vomiting. There was tenderness in the left iliac fossa. Ultrasonography revealed inconclusive findings and contrast-enhanced computed tomography of the abdomen and pelvis suggested possible left adnexal torsion. Hence, she underwent a diagnostic laparoscopy which revealed a twisted, edematous, and congested left fallopian tube. The diagnosis of isolated left fallopian tube torsion was made and she was managed with unilateral salpingectomy. Women of the reproductive age group are usually affected by this condition. The common presentations are abdominal pain, nausea, and vomiting. The physical examination may reveal abdominal and cervical motion tenderness. Per abdominal ultrasound is the first go-to modality in children. Magnetic resonance imaging, if available, is advised in children if the ultrasound is inconclusive because of the absence of radiation. However, it may require sedation. Therefore, contrast-enhanced computed tomography abdomen gives an added advantage in such scenarios as in our case. This condition is managed by surgery with salpingectomy or tube detorsion with preservation of the tube, depending on the intraoperative findings. Clinicians should be aware of the condition given the rarity and challenges in the diagnosis of isolated fallopian tube torsion.

Diagnostic accuracy of pelvic examination in pelvic inflammatory disease: A meta-analysis.

Pelvic inflammatory disease (PID) is not a mere transient infection. PID can lead to chronic pain, ectopic pregnancy, and infertility. Although the Centers for Disease Control and Prevention have established minimum diagnostic criteria, including pelvic examination, the diagnostic value of pelvic tenderness has recently garnered controversy. Our meta-analysis aimed to confirm whether pelvic tenderness, cervical motion tenderness, and adnexal tenderness can help diagnose PID. We searched for studies reporting the diagnostic test accuracy of pelvic tenderness, cervical motion tenderness, and adnexal tenderness among female patients at risk for PID, using MEDLINE, EMBASE, CENTRAL, CINAHL, Google, and Google Scholar through May 25th, 2022. After quality assessment using QUADAS-2, we performed data synthesis using a bivariate random effect model and Bayesian hierarchical summary receiver operating characteristic model. We then conducted sensitivity analysis excluding studies with non-PID cases. The literature search produced 6769 articles. After quality assessment, 14 studies and their 2808 participants were eligible for synthesis on pelvic tenderness. Laparoscopy, either alone or in combination, was the most frequent reference standard. The main results for pelvic tenderness sensitivity and specificity were 0.81, 95% confidence interval (CI) [0.67-0.90] and 0.40, 95% CI [0.25-0.57], respectively. Sensitivity and specificity were 0.72, 95% CI [0.57-0.83] and 0.50, 95% CI [0.34-0.66], for cervical motion tenderness, and 0.87 [0.64-0.96] and 0.27, 95% CI [0.12-0.52] for adnexal tenderness, respectively. Our meta-analysis suggests that pelvic tenderness assessed by pelvic examination may be useful for PID examination with moderate-to-high sensitivity, whereas clinicians should be aware of the diagnostic significance of pelvic tenderness.

Role of usg in Ectopics: Recent Update

This study is undertaken to emphasize the role of ultrasonography in the diagnosis of ectopic pregnancy and clinicalanalysis of the same in a tertiary care referral hospital.MethodologyOne hundred patients with provisional diagnosis of ectopic pregnancy were studied. Physical examination, urinepregnancy test, transabdominal scan using 5 MHz transducer or transvaginal ultrasonography of 7 MHz was done. Thediagnosis of ectopic pregnancy was confirmed by direct observation by laparotomy or laparoscopy (which was taken asgold standard).ResultsThe study showed ectopic pregnancy was most common in gravida 2 and in age group 26–30 years with most of themhaving married life &lt;10 years. One or more risk factors were found in 66 % of cases. 54 % of cases presented with acutesymptoms, 14 % of cases in shock. Among clinical presentation pain abdomen, history of amenorrhea, bleeding pervaginum, abdominal tenderness, and cervical motion tenderness was most common. In ultrasonography, complex massin adnexa was present in 60 % of cases and hemoperitoneum in 50 %. 96 % of cases were tubal pregnancy with most ofthem tubal rupture. In 98 % of cases, radical surgery was done. Salpingectomy was the most common surgery done (90%). There was no negative laparotomy in this study. There was no maternal mortality in this series.ConclusionsIn all the 100 cases of ectopic pregnancy studied, the ultrasonography provided definitive diagnosis resulting in 100 %sensitivity and 100 % specificity, predictive value of positive test being 100 %. Ultrasonography done in earlier weeks ofgestation had sensitivity of 96 % and false negative 4 %

A rare case of recurrent group A streptococcal vulvovaginitis in a premenopausal woman.

A rare case of recurrent group A streptococcal vulvovaginitis in a premenopausal woman.

Clinical features of isolated Fallopian tube torsion: evidence from a large series

We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98–33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01–7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70–0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22–0.96); (v) vomiting (aOR 95% CI 0.38, 0.19–0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18–0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion.

Preoperative Clinical Features of Isolated Fallopian tube Torsion: Evidence from a Large Series

Study Objective To study isolated fallopian torsion (IFTT) in a large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). Design A retrospective cohort study. Setting A tertiary, university affiliated medical center. Patients or Participants We included women with surgically confirmed ovarian and/or fallopian tube torsion between March 2011 and June 2020. We compared women with IFTT to those with NIAT during the same period. Interventions Diagnostic and operative laparoscopy. Measurements and Main Results Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Edematous and enlarged ovaries were less common in the IFTT group. In a multivariate regression analysis, the following factors were independently positively associated with IFTT; vaginal discharge [adjusted Odds Ratio (aOR) 95% CI 8.16, 1.98-33.55], and cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29). The following factors were independently negatively associated with IFTT; fertility treatments (aOR 95% CI 0.26, 0.70-0.77), previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96), vomiting (aOR 95% CI 0.38, 0.19-0.76) and enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). Conclusion We have identified preoperative factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. To study isolated fallopian torsion (IFTT) in a large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). A retrospective cohort study. A tertiary, university affiliated medical center. We included women with surgically confirmed ovarian and/or fallopian tube torsion between March 2011 and June 2020. We compared women with IFTT to those with NIAT during the same period. Diagnostic and operative laparoscopy. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Edematous and enlarged ovaries were less common in the IFTT group. In a multivariate regression analysis, the following factors were independently positively associated with IFTT; vaginal discharge [adjusted Odds Ratio (aOR) 95% CI 8.16, 1.98-33.55], and cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29). The following factors were independently negatively associated with IFTT; fertility treatments (aOR 95% CI 0.26, 0.70-0.77), previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96), vomiting (aOR 95% CI 0.38, 0.19-0.76) and enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). We have identified preoperative factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion.

Bacterial Vaginosis and Behavioral Factors Associated With Incident Pelvic Inflammatory Disease in the Longitudinal Study of Vaginal Flora.

Pelvic inflammatory disease (PID) leads to long-term reproductive consequences for cisgender women. Bacterial vaginosis (BV) and behavioral factors may play a role in PID pathogenesis. We assessed associations between BV, behavioral factors, and incident PID. We analyzed participants (N = 2956) enrolled in the National Institutes of Health Longitudinal Study of Vaginal Flora, a cohort of nonpregnant cisgender women followed quarterly for 12 months. PID was defined by at least 1 of the following: cervical motion tenderness, uterine tenderness, or adnexal tenderness (160 cases). We tested associations between BV (measured using Nugent and Amsel criteria) and PID at the subsequent visit. Sociodemographic factors, sexual behaviors, and Chlamydia trachomatis (CT), untreated at baseline and concurrent with BV, were covariates in Cox proportional hazards models. Adjusting for the few Neisseria gonorrhoeae and Trichomonas vaginalis cases did not alter results. In multivariable modeling, Nugent-BV (adjusted hazard ratio [aHR], 1.53 [95% confidence interval {CI}, 1.05-2.21]), symptomatic Amsel-BV (aHR, 2.15 [95% CI, 1.23-3.75]), and vaginal douching (aHR, 1.47 [95% CI, 1.03-2.09]) were associated with incident PID. BV was associated with incident PID in a large prospective cohort, controlling for behavioral factors and sexually transmitted infections (STIs). Larger studies on how BV, STIs, behaviors, and host responses interactively affect PID risk are needed.

CLINCIAL PRESENTATION AND ULTRASONOGRAPHIC MARKERS OF PID

INTRODUCTION: Pelvic inammatory disease (PID) comprises a spectrum of inammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, Tubo-ovarian abscess, and pelvic peritonitis. The CDC has estimated that more than I Million women experience an episode of PID every year. Studies have reported prevalence ranging from 5.2% to 17.2% PID in various parts of India. Ultrasound:- TAS was initially used followed by use of TVS with Doppler in diagnosis of PID, although there are no large studies evaluating its sensitivity and or overall usefulness. Itis a frequentlyordered study in patients with classic symptoms of PID or who have unexplained, acute pelvic pain. MATERIAL AND METHODS:A retrospective analysis of medical records of patients with a complaint of lower abdominal pain was included in the study. Diagnosis of PID was made and patient was followed in the outdoor clinic. Pelvic examination was made. USG was done. According to symptoms and clinical examination for PID patients, the data was recorded. Medical record of 120 patients from 1 January 2020 to 31 May 2021 from a private clinic in Dist. Shivpuri were studied. RESULTS: In our study out of 120 cases, most of the patients 50.83% belonged to 26-30 years of age, a maximum number of patients were rural 83.33%. Most of the patients were educated below HSC 56.66%. Most of them 85% were married and most of them were multipara 56.66%. The most common presenting complaint was a pain in the abdomen (100%), followed by per vaginal discharge (65%), pain in the lower back (43.33%), abnormal uterine bleeding (40%), dysmenorrhoea (31.66%), dyspareunia (24.16), fever (17.5%) and others. On clinical examination abnormal PV discharge was present in 61.66% of cases, xed and retroverted uterus with or without thickend appendages were found in 55% of cases. Cervical motion tenderness was found in 78.33% of cases. Adnexal tenderness was found in 80% of cases but adnexal mass was found in 10.83% of cases. The most common nding on ultrasound scan was uid in the pouch of douglas 48.33%, followed by distal hydrosalphinx 28.33%, endometritis 18.33%, pyosalpinx 15%, TO Mass 13.33% and Pelvic collection in 10.83% of cases. CONCLUSION:The focus of this study was to identied socio-demographic characteristics of PID, to see the variety of presenting complaints and pelvic examination ndings and to correlate the clinical ndings with the USG ndings of PID. Much studies about the sensitivity &amp; specicity of USG are not available, but this is denitely the most frequently ordered investigation in cases of PID. Transabdominal ndings of 'incomplete septa' 'cog wheel' 'beads on a strings' signs helps in distinguishing a dilated fallopian tube from other cystic adnexal masses To prevent long term sequelae PID should be the part of differential diagnosis in all patients aged 15-44 year with non specic abdominal pain.

Predictive Analytic Model for Diagnosis of Ectopic Pregnancy.

Objective: Ectopic pregnancy (EP) is a serious condition. Delayed diagnosis could lead to life-threatening outcomes. The study aimed to develop a diagnostic predictive model for EP to approach suspected cases with prompt intervention before the rupture occurred.Methods: A retrospective cross-sectional study enrolled 347 pregnant women presenting first-trimester complications (abdominal pain or vaginal bleeding) with diagnosis suspected of pregnancy of unknown location, who were eligible and underwent chart review. The data including clinical risk factors, signs and symptoms, serum human chorionic gonadotropin (hCG), and ultrasound findings were analyzed. The statistical predictive score was developed by performing logistic regression analysis. The testing data of 30 patients were performed to test the validation of predictive scoring.Results: From a total of 22 factors, logistic regression method–derived scoring model was based on five potent factors (history of pelvic inflammatory disease, current use of emergency pills, cervical motion tenderness, serum hCG ≥1,000 mIU/ml, and ultrasound finding of adnexal mass) using a cutoff score ≥3. This predictive index score was able to determine ectopic pregnancy with an accuracy of 77.8% [95% confidence interval (CI) = 73.1–82.1], specificity of 91.0% (95% CI = 62.1–72.0), sensitivity of 67.0% (95% CI = 88.0–94.0), and area under the curve of 0.906 (95% CI = 0.875–0.937). In the validation group, no patient with negative result of this score had an EP.Conclusion: Statistical predictive score was derived with high accuracy and applicable performance for EP diagnosis. This score could be used to support clinical decision making in routine practice for management of EP.

Febrile Illness in 3 Adolescent Patients.

Febrile Illness in 3 Adolescent Patients.

AYURVEDIC MANAGEMENT OF CHRONIC PID ASSOCIATED WITH CERVICAL INTRAEPITHELIAL NEOPLASIA - A CASE REPORT

Pelvic inflammatory disease (PID) is the inflammatory condition of uterus, and associated structures, which are often sexually transmitted. Human Papilloma Virus (HPV) infection is the most prevalent sexually transmitted infection as well as the most important risk factor for Cervical Intraepithelial Neoplasia (CIN) and Invasive Cervical Carcinoma (ICC). CIN are dysplastic changes taking a long period to progress into true cancer. Currently treatment is not recommended for CIN 1&amp;2 lesions as they are said to regress in some cases. According to Ayurvedic principles, Garbashaya Mukha Sopha, can be managed with Vranaropana-Ojovardhaka drugs. The symptomatic management with anti-inflammatory and immune-modulatory drugs along with Sthanika chikitsa, together gave promising results even in cytological level. A 43-year-old lady presented with thick yellowish discharge per vagina along with lower abdominal pain &amp; low back ache. On examination, hypertrophied and eroded cervix was noticed along with positive cervical motion tenderness. She was sent to Regional Cancer centre, Trivandrum for cytological evaluation, which revealed LSIL (Low grade Squamous Intraepithelial lesion) with Koilocytic atypia. She was managed with oral medication and Sthanika chikitsa and got relieved from symptoms which was consistent even after the follow up period. The cytology revealed negative for intraepithelial lesion or malignancy. Ayurvedic modalities proved to be effective in management of Chronic PID with CIN.

English

BACKGROUND Pelvic inflammatory disease is a spectrum of diseases affecting the female upper genital tract. It is a poly microbial infection and Chlamydia trachomatis is the most common causative agent. We have undertaken this study with the objective of determining the prevalence of Chlamydia trachomatis infection in pelvic inflammatory disease (PID). METHODS This cross-sectional study consisted of 100 non-pregnant women with clinical features of PID. Endocervical, vaginal swabs and blood samples were collected from them. Polymerase-chain-reaction test (PCR) and enzyme-linked immunosorbent assay (ELISA) for chlamydial detection and Gram’s staining &amp; culture for other pathogens were performed. Chi-square and Fisher’s exact tests were used to study association between the clinical features and Chlamydia trachomatis positivity. RESULTS The prevalence rate of chlamydia was 15.1 %. The other organisms isolated were candida species in 12.9 % and Escherichia coli in 5.3 % of the study population. There was no association between the various demographic variables, menstrual problems, fever, urinary symptoms, history of infertility, abortions, instrumentations and the presence of Chlamydia trachomatis. A significant association was found between the lower abdominal pain which increased during menstruation (P = 0.013) and the two clinical signs, cervical motion tenderness and uterine tenderness (P = 0.001) with the presence of Chlamydia trachomatis and other cervical infections. CONCLUSIONS The prevalence rate of Chlamydia trachomatis in pelvic inflammatory disease was 15 % and other organisms isolated from the cervical swabs were candida species and Escherichia coli. KEY WORDS Pelvic Inflammatory Diseases, Chlamydia trachomatis

Clinical Study of Ectopic Pregnancy in Al-Zahra Teaching

An ectopic pregnancy is one in which fertilized ovum is implanted at the site other than normal uterine cavity.[1] Incidence of ectopic pregnancy is 1:160 deliveries.[2]Clinical presentation is variable from acute to chronic type. Due to its varied clinical presentation ectopic pregnancy poses great diagnostic difficulty both to obstetrician, physician and surgeons.[3] OBJECTIVE: To find out incidence in our study population and to evaluate symptomatically and clinical presentation in these patients. MATERIALS AND METHODS: Retrospective study of 34 ectopic pregnancies admitted and treated in Al-zahra Teaching Hospital from 2015 to 2020 are included in the study. RESULTS : The incidence of ectopic pregnancy is more between the age group of 21-30years (73.52%) and in Multigravida 64.71%. Infertility and previous tubal surgery are the high risk factors for tubal pregnancy. Pain in abdomen was present in all 34 cases, amenorrhea in 97.05% and bleeding per vagina in 76.47% cases. Syncopal attacks, vomiting were detected in 14.70% cases. Acute ectopic pregnancy was detected in 14.71% and chronic in 85.29% cases. 82.35% cases presented with adnexal mass, 79.41% with cervical motion tenderness, 50% with pallor, 32.35% with abdominal lump and tenderness and 11.76% with fullness in POD. CONCLUSION : Ectopic pregnancy is leading cause of maternal mortality in first trimester. In spite of advanced diagnostic techniques. It poses great diagnostic difficulties due to varied signs and symptoms. Previous tubal surgery pelvic inflammatory disease and infertility are the risk factors of tubal pregnancy. KEYWORDS : Ectopic pregnancy, Salpingectomy, Ovarian pregnancy. DOI: 10.7176/JHMN/81-03 Publication date: October 31 st 2020

A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador.

Background Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.