Chronic Pelvic Inflammatory Disease Research Articles

A randomized, double-blind, positive-controlled, Phase-II clinical trial to evaluate efficacy and safety of Fuke Qianjin capsule in Pakistani patients with pelvic inflammatory disease.

Ethnopharmacological relevance: Pelvic inflammatory disease (PID) is a frequently occurring gynecological disorder mainly caused by the inflammation of a woman's upper genital tract. Generally, antibiotics are used for treating PID, but prolonged use poses potential risks of gut bacterial imbalance, bacterial resistance, super bacteria production, and associated adverse reactions. Traditional Chinese medicine (TCM) has shown unique advantages in various ailments and has received widespread clinical research attention. Fuke Qianjin (FUKE) capsule is an approved National Medical Products Administration (NMPA License No. Z20020024) Chinese herbal prescription that has been widely used individually or in combination with other Western medicines for the treatment of various gynecological inflammatory diseases, including chronic cervicitis, endometritis, and chronic PID. Aim: This clinical trial was designed to assess the safety and efficacy of FUKE capsule in mild-to-moderate symptomatic PID patients. Materials and methods: This phase 2, randomized, double-blind, positive controlled clinical trial was conducted in mild-to-moderate symptomatic PID patients at a single center in Pakistan from 21 September 2021 to 11 March 2022. Eligible female participants were randomly assigned to a test and a control group with a ratio of 1:1. The test group subjects received two metronidazole (METRO) tablets and one doxycycline hyclate (DOXY) simulant at a time, twice daily for 14 days, and two Fuke Qianjin (FUKE) capsules, three times a day after a meal for 28 days. Subjects in the control group received two METRO tablets and one DOXY tablet at a time, twice daily for 14 days, and two FUKE simulant capsules, three times a day after meal for 28 days. The primary efficacy outcome was an improvement in pelvic pain symptoms assessed through a visual analog scale (VAS). The secondary outcomes were the improvement in secondary efficacy symptoms like local physical signs, clinical assessment of leucorrhea and cervical secretions through laboratory examination, and improvement in the maximum area of pelvic effusion assessed through gynecological ultrasound after the treatment. The safety outcomes were assessed through vital signs, laboratory tests, electrocardiogram findings, and adverse events/serious adverse events. Results: A total of 198 subjects with active PID were randomly assigned to a test group (n = 99) and a control group (n = 99). The baseline characteristics of the subjects in the two groups were similar. In the intention-to-treat analysis, the primary efficacy was 84.9% for the test group and 71.6% for the control group, with a statistically significant difference (p = 0.0370; 95% CI -0.2568 to -0.0088). The secondary clinical efficacy was 88.4% for the test group and 82.7% for the control group, with no significant difference (p = 0.2977; 95% CI -0.1632 to 0.0501). The improvement in local physical signs was 95.8% for the test group and 76.9% for the control group, with no significant difference (p = 0.0542; 95% CI -0.3697 to -0.0085). The inter-group non-inferiority comparison showed that the upper limit of the 95% CI was less than 0.15 and thus met the non-inferiority requirements of the test group to the control group. The results of clinical signs of leucorrhea and cervical secretions showed that there was no difference in the rate of improvement between the test and control groups, indicating that FUKE was non-inferior to DOXY. A total of 14 adverse events in eight subjects were observed in the trial, with an incidence rate of 4.7%. Four subjects in each group experienced seven adverse events with 4.5% and 4.8% incidence rates of adverse reactions in the test and control groups, with no statistically significant differences (p = 0.2001). No serious adverse events occurred in the trial. Conclusion: The results of this trial indicate that the test drug (Fuke Qianjin capsule) is non-inferior to the control drug (doxycycline hyclate tablet) in treating mild-to-moderate PID patients with comparable efficacy, safety, and tolerability to the control drug. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT04723069.

A case series on live ectopic pregnancy

A pregnancy which develops outside uterus is called ectopic pregnancy that comprises nearly two percent of total pregnancies. In first case a 25years old female presented with lower abdominal pain and bleeding per vagina with 3 months of amenorrhea and history of irregular oral contraceptive pill use. A live ectopic pregnancy of 12 weeks 3 days gestation found on right fallopian tube during laparotomy and right salpingectomy was done. In second case, a third gravida mother presented with bleeding per vagina and lower abdominal pain with history of 2.5 months of amenorrhea and chronic pelvic inflammatory disease. During laparotomy, both sided hydrosalpinx and left sided live ectopic pregnancy found on the distal end of fallopian tube and left salpingectomy with fimbriectomy with right sided tubal ligation was done. In third case, a third gravida mother with history of lower uterine caesarean section and ruptured left sided tubal ectopic pregnancy previously, presented with lower abdominal pain with 2 months of amenorrhea. Ultrasonography diagnosed a live right sided cornual ectopic pregnancy of 6weeks 6days and conservative management with injection methotrexate was started. Later due to sudden hemodynamic instability, emergency laparotomy was done and ruptured right cornual ectopic pregnancy was found and treated with total abdominal hysterectomy. All these cases were managed successfully. This case series emphasizes that early serological and sonographic diagnosis of location of pregnancy is necessary, there should be high suspicion for ectopic pregnancy even beyond the first trimester and the decision of conservative management in early ectopic pregnancy should be taken judiciously after checking all parameters of the patient.

Efficacy of Combined Treatment with Clindamycin and Ultrasound in Chronic Pelvic Inflammatory Disease

Efficacy of Combined Treatment with Clindamycin and Ultrasound in Chronic Pelvic Inflammatory Disease

Prescribing Pattern of Antimicrobial Agents in Patients with Pelvic Inflammatory Disease in a Tertiary Care Hospital at Rural Part of Western Nepal

Introduction: Antibiotics are the most frequently prescribed drugs in patients with Pelvic Inflammatory Diseases. Appropriate antibiotic prescriptions in health care institutions are an important element in quality of care, infection management and cost control.
 Aims: To analyze prescription pattern of antimicrobial agents in patients with pelvic inflammatory diseases.
 Methods: This quantitative cross-sectional study was conducted including 300 patients' prescriptions, at Karnali Academy of Health Sciences Jumla Nepal for period of six months during August 2021 to January 2022. This study was based on medication utilization form, which was designed on basis of World Health Organization core drug use indicator format.
 Results: Females were in ages from 12 to 69 years, with mean of 30.46 ± 18.71 years. Chronic Pelvic inflammatory Disease was most prevalent in 20–29 age group (47%) while, lowest in 60–69 age group (1.67%). The total number of prescribed drugs was 796 averaging 2.65 drugs per prescription. The most commonly prescribed antimicrobials were azithromycin (30.15%), tinidazoles (25.25%) and ofloxacin (8.16%). Only 15.5% of drugs were prescribed with generic names and all were from essential list of medicines. 92.8% of prescriptions were administered orally, while 7.8% parenteral. However 76.34% of prescriptions were considered irrational.
 Conclusion: The high prevalence of irrational prescriptions suggests need for interventions to improve healthcare provider's adherence to established treatment guidelines. Dominance of specific drug classes underscores importance of tailoring treatments to the specific pathogens involved in Pelvic Inflammatory Disease. Suggesting potential room for improvement inadherence to evidence-based guidelines.

The Impact and Correlation of Anxiety and Depression on Pressure Pain Threshold of Acupoints in Patients with Chronic Pelvic Inflammatory Disease.

Chronic pelvic inflammatory disease (CPID) is a clinically common gynecological disease. Patients experience chronic pelvic pain and often accompany with emotional dysfunction. However, the impact and correlation of anxiety and depression on pain sensitization is not completely known. To explore the differences and correlations among anxiety, depression, and pressure pain threshold (PPT) of acupoints in patients with CPID. One hundred and forty-seven patients with CPID were recruited. The Visual Analog Scale (VAS) and short-form McGill Pain Questionnaire (SF-MPQ) were used to assess pain. Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate the emotional state of patients. The PPT of acupoints was collected using an electronic Von Frey by two licensed acupuncturists. The CPID patients were divided into anxiety-depression group (group A) or nonanxiety-depression group (group B), according to the SAS and SDS scores. Finally, there were 73 patients in group A and 74 patients in group B. Group A had significantly higher SAS, SDS, VAS, and SF-MPQ scores than group B (P < 0.05). In addition, significant differences were observed in the PPTs of ST28 (R), ST29 (R), SP10 (R), SP9 (R), SP9 (L), ST36 (R), and LR3 (L) between the two groups (P < 0.05). No considerable differences in PPTs at the other acupoints were observed between the two groups. SAS scores showed a positive correlation with PPTs of ST29 (R), SP10 (R), SP9 (L), ST36 (R), and LR3 (L). No remarkable correlation was observed between the SDS scores and PPTs. Anxiety and depression can affect the PPT of some acupoints in CPID patients, which may provide a reference for acupoint selection for acupuncture treatment of CPID with emotional disorders. This trial is registered with ChiCTR2100052632.

Disorder of the Microbiota and Mucosal Immunity of the Genital Tract in Women of Reproductive Age with Different Clinical Courses of Acute Uncomplicated Pyelonephritis

The research deals with the study of immuno-microbiological parallels of the genital tract in women with acute uncomplicated pyelonephritis with concomitant chronic pelvic inflammatory diseases. In addition to etiotropic antibacterial therapy, correction of the mucosal immunity state of the genital tract is crucial for the treatment of the disease and prevention of its recurrence. The purpose of the work was to investigate the contamination and state of local immunity of the genital tract in women with acute uncomplicated pyelonephritis with different clinical courses. Methods. 246 women of reproductive age suffering from acute uncomplicated pyelonephritis were studied, divided into three variants of the disease clinical course: group 1 - mild (n=105), group 2 - moderate (n=90), and group 3 - severe (n=51) courses. The scrapings of the mucous membrane of the cervical canal and washings from the vagina were obtained before the start of antimicrobial therapy. Quantitative determination of pathogens was carried out by sowing the biological material on solid nutrient environment. Identification of detached bacteria was carried out according to Bergeys. Mollicutes (Ureaplasma spp., Mycoplasma hominis) were determined by the cultural-fermentative method using test systems and the polymerase chain reaction. Vaginal washings of 121 sick women were used for immunological studies. The levels of myeloperoxidase, lysozyme, human β-defensin-2, immunoglobulins M, A, G, secretory IgA, lactoferrin, C3-component of complement, secretory component, and tumor necrosis factor-α were determined. The reference group consisted of 23 clinically healthy women. The Statistica 12.0 program package for Windows was used, and a difference of p&lt;0.05 was considered verifi able. Results. In the majority of patients with acute uncomplicated pyelonephritis (85.6% of cases), concomitant chronic pelvic inflammatory diseases (colpitis, salpingitis, underlying medical condition of cervix) were observed. Classical bacteria were more often detected in vaginal washings of patients of all groups, while mollicutes were detected in scrapings of the mucous membrane of the cervical canal, whereas the frequency of their detection increased with increase in the pyelonephritis severity. The analysis of indicators of local immunity determined disorders of mucosal immunity of the genital tract in the form of increased levels of myeloperoxidase, IgA, and IgG relative to reference values. The highest levels of lysozyme and myeloperoxidase were determined in patients with a severe course of acute uncomplicated pyelonephritis (by 5.3 and 3.6 times more, respectively), and the content of immunoglobulins A, M, and G in patients with a mild course of the disease (by 3.2, 3.1, and 4.0 times more, respectively). An increase in the level of tumor necrosis factor-α was detected in all patients, although no significant differences from controls were found in any group, but the highest median value was recorded in patients with severe pyelonephritis. In the group of patients with a severe clinical course, the lowest median was observed for β-defensin-2, which makes it impossible to inhibit the synthesis of TNF-α and, thus, supports the inflammatory process. Conclusions. It has been proven that in women with acute uncomplicated pyelonephritis, the severity of the course probably correlates with infection of the genital tract by mollicutes, mainly in association with classical bacteria and with level of mucosal immunity disorder. The obtained results of microbiological and immunological studies of biological material collected before the start of antibacterial therapy in patients with acute uncomplicated pyelonephritis proved the need for a mandatory examination by a gynecologist to ascertain concomitant chronic pelvic inflammatory diseases and establish infection with mollicutes to provide relevant etiotropic treatment. The above is the basis for adding the data regarding laboratory examination and treatment to the management protocols of patients with acute uncomplicated pyelonephritis.

Flavonoids from Smilax china L. Rhizome improve chronic pelvic inflammatory disease by promoting macrophage reprogramming via the NLRP3 inflammasome-autophagy pathway

Flavonoids from Smilax china L. Rhizome improve chronic pelvic inflammatory disease by promoting macrophage reprogramming via the NLRP3 inflammasome-autophagy pathway

Diagnostically significant changes in subsets CD11b&lt;sup&gt;+&lt;/sup&gt;CD64&lt;sup&gt;-&lt;/sup&gt;CD32&lt;sup&gt;+&lt;/sup&gt;CD16&lt;sup&gt;+&lt;/sup&gt;, CD11b&lt;sup&gt;+&lt;/sup&gt;CD64&lt;sup&gt;+&lt;/sup&gt;CD32&lt;sup&gt;+&lt;/sup&gt;CD16&lt;sup&gt;+&lt;/sup&gt; neutrophilic granulocytes of immunocompromised women with chronic infectious and inflammatory diseases of the genital tract of various etiologies

Chronic pelvic inflammatory disease (PID) in women remains a problem due to the importance of medical consequences. The study of the receptor apparatus of neutrophilic granulocytes (NG) involved in anti-infective protection in diseases of various etiologies seems to be relevant. Aim: to clarify the features of variants of quantitative and phenotypic changes in subsets of NG CD11b+CD64-CD32+CD16+, CD11b+CD64+CD32+CD16+ of immunocompromised women during exacerbation of chronic PID of various etiologies. We were tested women 20-40 years: Study Group 1 (SG1, n = 20) – chronic PID during the exacerbation with mono- or mixed latent/recurrent various viral infections (chronic herpes-virus infections, papillomavirus infection, recurrent ARVI); Study Group 2 (SG2, n = 30) – chronic PID of bacterial etiologies; Comparison Group (CG)– 20 healthy women. The number of subsets CD11b+CD64-CD32+CD16+NG (major) and CD11b+CD64+CD32+CD16+NG (minor), receptor expression density (MFI) was determined (FC500, USA). It was found that in PID during the period of exacerbation, diagnostically significant differences in the subset composition of NG were revealed. We got a decrease in the CD11b+СD64-СD32+СD16+NG subset and in 7,6 times increase in the CD11b+CD64+CD32+CD16+NG subset in SG2 with chronic PID of bacterial etiology, in contrast to chronic PID occurring in combination with recurrent/persistent viral infection SG1. Negative transformation of NG subsets is associated with a predominant decrease in the level of expression of the activation CD16. The absence of an adequate response to the infectious and inflammatory process was revealed – the absence of an increase in the expression of the activation CD11b in the major subset in SG1, as well as in the minor subset in groups SG1 and SG2. In the major subset of NG in groups SG2 a decrease in the expression of the activation marker CD11b. In the various viral infections and PID (SG1), in the negatively altered minor subset of NG we got a decrease of expression of CD16, an increase of expression of CD64 and CD32. Determination of subsets of CD11b+СD64-СD32+СD16+, CD11b+CD64+CD32+CD16+NG and their phenotype can be used as diagnostic markers for the differential diagnosis of PID of viral and bacterial etiology, and for the development of new methods of targeted immunomodulatory therapy.

Mechanisms of Wuyao (Linderae Radix) in treating chronic pelvic inflammatory disease based on network pharmacology and animal experiments

ObjectiveTo predict the active components and action targets of Wuyao (Linderae Radix) in the treatment of chronic pelvic inflammatory disease (CPID) based on network pharmacology, explore possible mechanisms of the treatment through animal experiments, and provide a scientific basis for clinical applications of Wuyao (Linderae Radix). MethodsPossible active components and targets of Wuyao (Linderae Radix) in the treatment of CPID were obtained applying network pharmacology and molecular docking technology. CPID rat models were established using the mixed Escherichia coli, Staphylococcus aureus, and Ureaplasma urealyticum plus the performance of mechanical injury. Hematoxylin-eosin (HE) staining was applied to observe the pathological changes in the uterus, fallopian tube, and spleens of rat models. The contents of nitric oxide (NO), superoxide dismutase (SOD), and malondialdehyde (MDA) in the serum of rats were determined with the use of corresponding detection kits. Enzyme-linked immunosorbent assay (ELISA) test was used to measure the expression of interleukin (IL)-6 and IL-10 in the serum of rat models. Flow cytometry was used to determine the percentage of CD4+ and CD8a+ T cells as well as CD4+ CD25+ regulatory T cells (Tregs) in the spleen of rat models. ResultsA total of nine potential active components and four core therapeutic targets related to inflammatory response in Wuyao (Linderae Radix) were obtained. The animal experiments showed that Wuyao (Linderae Radix) markedly inhibited uterus swelling, regulated morphological changes in the fallopian tube and spleen, effectively reduced inflammatory infiltration and injuries in the uterus and fallopian tube, and improved spleen functions in CPID rats. Moreover, Wuyao (Linderae Radix) markedly reduced the levels of NO, IL-6, and MDA, and increased the levels of IL-10 and SOD in the serum of rats. Wuyao (Linderae Radix) also elevated the percentage of CD4+ T cells and the CD4+ T/CD8a+ T cell ratio, reduced the percentage of CD8a+ T cells, and raised the percentage of CD4+ CD25+ Tregs that had been abnormally decreased in rat models (P < 0.05). ConclusionWuyao (Linderae Radix) could have therapeutic effects on CPID rats by relieving oxidative stress, mitigating inflammatory levels, and regulating the immuno-function of T cell subgroups to improve the pathological changes in CPID rats. It is a medicinal herb worth being further explored for its clinical values.

Rare Variants of Malignant Peritoneal Mesothelioma: a Literature Review.

Primary peritoneal mesothelioma (PM) is a rare and aggressive malignancy that arises from the peritoneum and classified into diffuse malignant peritoneum mesothelioma (DMPM) and borderline variants, viz. multicystic peritoneal mesothelioma (MCPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM). The borderline variants are rarer than conventional DMPM, are less aggressive form accounting for 3-5% of all cases of peritoneal mesothelioma. In this narrative review article, we have discussed the pathogenesis, clinical presentation, natural history, and management of these rarer variants of PM, viz. MCPM and WDPPM. Histologically, MCPM typically consists of small cysts composed of mesothelial epithelium with benign bland cuboidal cells with clear fluids; cells lack cellular atypia and have increased number of mitoses. WDPPM has specific papillary component with myxoid plump cores and single layer of bland mesothelial cells. Both the variants commonly present as incidental finding or symptoms of chronic abdominal pain, chronic pelvic inflammatory disease, pelvic mass, and infertility. In the absence of treatment, these diseases are slow growing with major concerns being that both the variants have malignant transformation capabilities and a high rate of recurrence. In the light of current evidences, it is recommended that MCPM and WDPPM patients should be offered a complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy consisting of cisplatin and doxorubicin. Collaborative multi-institutional studies are needed to generate more data and formulate robust guidelines.

Clinical effect of Guizhi Fuling Pill combined with metformin on chronic pelvic inflammatory disease and its influence on inflammatory reaction in rats.

Clinical effect of Guizhi Fuling Pill combined with metformin on chronic pelvic inflammatory disease and its influence on inflammatory reaction in rats.

Atypical presentation of vesicouterine fistula (Youssef’s syndrome) post-caesarean gossypiboma: a case report

Vesicouterine fistula as described by Youssef manifests with amenorrhea, and cyclic haematuria (menouria) without urinary incontinence commonly following caesarean section. Other aetiologies have been reported for this disease. The post-caesarean section gossypiboma, a dual aetiology causing this condition is rare and can make its presentation atypical, thus posing a diagnostic dilemma. The clinical evaluation alone in the atypical presentation of the vesicouterine fistula is insufficient except complemented by imaging investigations and endoscopic examination of the related organs. We report a case of vesicouterine fistula that was managed initially as chronic pelvic inflammatory disease despite urinary incontinence until further evaluation including a transvaginal ultrasound scan and urethrocystoscopy raised an index of suspicion of a vesical mass suggestive of gossypiboma. The mass was confirmed to be a foreign body, an abdominal gauze pack, or gossypiboma. Its removal and repair of the vesicouterine fistula were associated with a satisfactory outcome.

A CASE REPORT- AYURVEDIC MANAGEMENT OF PARIPLUTAYONIVYAPADA W.S.R TO PELVIC INFLAMMATORY DISEASE

Background: Pelvic inflammatory disease (PID) is an upper genital tract disease. It includes the uterus, fallopian tube, ovaries, pelvic peritoneum, and surrounding structures, most commonly seen in reproductive age. It occurs most commonly in sexually active females. Main clinical symptoms are pain in the lower abdomen, foul-smelling vaginal discharge, painful sex, painful urination, irregular bleeding hemato-salpinx, tubo -ovarian mass are late complications of PID.According to Ayurveda PID can be correlated with Pariplutayonivyapada. Vata and Pitta are main Dosha in Pariplutayonivyapada according to Acharya Charka. Case: This article presents a case report of a patient aged 30 years married female for 11 years, she had normal delivery, age of child is 7year, h/o one abortion POG was 16 weeks, and cause was unknown before 2 years. Complain with pain in lower abdomen and white discharge. Treatment:PlannedwasSthanikchikitsaYonidhavan through Triphalakwatha and Yonipichu with Jatyadi Tail, whileShamanachikitsa with TriphalaGuggulu, Pushyanugchurna and Ashwagandha Churna. Result: Patient feel good and no any sign and symptoms of PID, His last USG report showed normal scan (no fluid seen, noPyosalipinx, hemato-salpinx seen) after 2 months Ayurvedictreatmentof chronic PID.

Chinese herbal medicine hot package therapy and nursing management for a patient with cold-dampness stasis type abdominal cold pain caused by chronic pelvic inflammatory disease

Chinese herbal medicine hot package therapy and nursing management for a patient with cold-dampness stasis type abdominal cold pain caused by chronic pelvic inflammatory disease

Nursing of a patient with infertility caused by chronic pelvic inflammatory disease treated with the Chinese herbal medicine ointment rubbing therapy

Nursing of a patient with infertility caused by chronic pelvic inflammatory disease treated with the Chinese herbal medicine ointment rubbing therapy

Incidence of Chronic Pelvic Pain in Females Attending a Gynaecology Outpatient Department

Background and Aims: Chronic pelvic pain (CPP) is a persistent pelvic pain that leads to reduced work performance and impaired quality of life in females. Nearly 15% of females report time off from paid work and around 45% report reduced work productivity. There is a paucity of studies to address the issue, especially with a multidisciplinary and multifactorial view. Various gynaecological disorders are associated with CPP such as endometriosis, adenomyosis, adhesions, chronic pelvic inflammatory disease, and pelvic congestion syndrome. The objective is to determine the frequency of CPP in females attending gynaecologic outpatient departments. Materials and Methods: A total of 201 patients aged 14–48 years attending the gynaecologic outpatient department for gynaecological disorders with complaints of lower abdominal pain were included in this study. Patients enrolled in the study were assessed by a detailed history and pelvic examination, and a structured questionnaire was filled out. Data were analysed using the statistical package for social sciences version 23.0 (International Business Machines Corporation, Armonk, New York, USA). Results: The mean age of the patients was 32.39±6.98 years. The frequency of CPP in females was observed as 95.52% (95% confidence interval: 91.67–97.93%) The rate of CPP was significantly high in females with parity ≤5 and those who had a duration of pain lower than 36 months. In multivariate analysis, adjusted odds ratio by stepwise logistic regression model showed that parity (parity 0–1) and duration of pain (≤36 months) were significantly associated with CPP in females. Conclusion: The study indicates that the most common gynaecological causes of CPP in females attending the outpatient department were those with endometriosis followed by adenomyosis. The management of CPP needs patient-centred care with a multidisciplinary approach. This will lead to early and effective management.

Наружный генитальный эндометриоз: клинико-анамнестические факторы риска у женщин репродуктивного возраста

Aim. To identify clinical and anamnestic risk factors for the development of external genital endometriosis. Design. Prospective cohort study. Materials and methods. As part of the study, 80 women of fertile age were examined: 54 patients with external genital endometriosis, confirmed by laparoscopy and histological examination (main group), and 26 women of the control group without external genital endometriosis. All participants were interviewed and examined in accordance with the applicable regulatory documents. Results. There were no significant differences in average age, level of education, body mass index, menstrual and reproductive functions, frequency of smoking and the structure of surgical interventions between two groups. However, the endometriosis patients were distinguished by a higher frequency of the digestive system diseases, namely chronic gastritis (p = 0.019); anemia (p = 0.174); benign breast dysplasia (p = 0.304); adhesions in the abdominal cavity (p = 0.095). On the contrary, the frequency of chronic inflammatory diseases of the uterine appendages was higher in the control group (p = 0.0000), which can be explained by the inclusion criteria in this group (planned laparoscopy due to infertility and/or chronic pelvic inflammatory disease). Patients of both groups are characterized by a low parity — on average, less than 1 birth per woman, which can partly be explained by the high frequency of infertility in the studied cohort: 38.8% of all examined, 24.1% of women with external genital endometriosis and 69.2% of women in the control group with a statistically significant predominance in the latter (p = 0.0001). Conclusion. Insufficient diagnostic effectiveness of existing methods of noninvasive verification of external genital endometriosis dictates the need to develop techniques based, among other things, on the consideration of clinical and anamnestic risk factors for the disease development. In addition, the elimination of the detected risk factors can contribute to the prevention of endometriosis development and recurrence after its treatment. Key words: external genital endometriosis, risk factors, noninvasive diagnostics.

RUPTURED TUBO-OVARIAN ABSCESS: RARE PRESENTATION OF PELVIC INFLAMMATORY DISEASE - A CASE REPORT

Background: Infection of the endometrium, fallopian tubes, ovaries, pelvic peritoneam, and adjacent structures is known as Pelvic Inflammatory Disease (PID). Pelvic inflammatory disease and its consequences are still at epidemic levels, Despite the availability of effective broad-spectrum antibiotics. Tubo-ovarian abscess (TAO) may be difficult to identify since the clinical signs are comparable to those of other pelvic and abdominal illnesses. Case Description: Here we are reporting a case, 34 years nulligravida came to emergency department with acute abdomen, she was a known case of chronic PID, Emergency laparotomy was performed, per operatively ruptured tubo-ovarian abscess was present. Conclusion: The clinical diagnosis of PID and TAO is similar, imaging evidence from ultrasonography (US) or magnetic resonance (MR) should be used to supplement the clinical diagnosis. Clinical Significance: To avoid complications and resultant emergency surgeries and their consequences, a vigilant eye must be kept to promptly diagnose, and manage PID at the earliest.

Peculiarities of clinical characteristics of pregnant with symptoms of Great obstetrical syndromes

The objective: to establish the risk factors for development of great obstetrical syndromes (GOS) on the basis of a prospective analysis of somatic, reproductive, obstetric anamnesis in pregnant women with clinical manifestations of GOSMaterials and methods. We conducted the analyses of somatic, reproductive and obstetrical history of 572 pregnant with clinical symptoms of GOS, who had the following complications: 21 – preeclampsia, 38 – preterm deliveries, 13 – placental abruption, 457 – gestational anemia, 27 – intrauterine growth retardation, 16 – fetal distress, that were diagnosed based on clinical, functional, laboratory, ultrasound, cardiotocographic and morphological investigations. All these complications are included in the group of GOS.Statistical analyze was conducted by using standard programs of Microsoft Excel 5.0 and Statistica 6.0.Results. The average age of the pregnant women was 26.5±2.3 years, most of them were in young reproductive age. The prevailing diseases in the structure of somatic pathology were thyroid gland pathology – 427 (74.6 %) persons, anemia 182 (31.8 %), arterial hypertension – 114 (19.9 %), kidney diseases – 241 (42.1 %) and diseases of gastro-intestinal tract –187 (32.7 %). Disorders of menstrual cycle were determined in 137 (23.9 %) women, chronic pelvic inflammatory diseases – 98 (17.1 %), background diseases of cervix (erosion, cervical dysplasia) had 142 (24.8 %) patients in anamnesis, colpitis – 296 (51.7 %), polycystic ovaries – 74 (12.9 %). The following pregnancy complications were diagnosed as preeclampsia – in 21 (3.7 %) persons, threatened preterm interruption of pregnancy in different gestational terms – in every third pregnant women (192 individuals – 33.7 %), anemia – 457 (79.9 %), preterm delivery – 38 (6.6 %) women, placental abruption – 13 (2.3 %), fetal growth retardation – in 27 cases (4.7 %), fetal distress – 16 (2.8 %). The rate of cesarean section in this group was 28.8 %.Conclusions. The identified peculiarities of somatic, reproductive history and obstetrical and perinatal pathology in pregnant with complications from GOS group allowed to define the following risk factors of their development: young reproductive age, significant frequency of socio-hygienic, medical and demographic and socio-psychological problems, complicated somatic, gynecological and reproductive history.

Analysis of Clinical Curative Effect of Obstetrics and Gynecology on Chronic Pelvic Inflammatory Disease

Analysis of Clinical Curative Effect of Obstetrics and Gynecology on Chronic Pelvic Inflammatory Disease