Can the impact of pelvic inflammatory disease on fertility be prevented? Epidemiology, clinical features and surgical treatment: evolution over 8 years.
OBJECTIVE
To assess the epidemiological features and the trend of care of patients diagnosed with pelvic inflammatory disease (PID) and to assess most predictive parameters of severe disease, for which surgical management is warranted, in particular when surgery is certain to cause permanent infertility.


METHODS
The study population was divided into 3 groups: medical therapy only, conservative surgery, and destructive surgery (surgical procedures that impaired fertility). Data from the 3 groups were compared with respect to general and medical history data, clinical signs on admission, laboratory tests, and ultrasound findings. The p value was considered significant when < 0.05.


RESULTS
The non-Italian women in the study appeared to be more at risk of developing PID and were overrepresented in the surgically treated groups. C-reactive protein (CRP) and D-dimer values most likely correlated with disease severity. Ultrasound evidence of ovaritis generally led to medical therapy. Conversely, when sonography revealed pyosalpinx or tuboovarian abscesses, surgery was performed.


CONCLUSIONS
Clinical presentation is fundamental in diagnostic counseling but should be supplemented with further laboratory tests to detect inflammation and sonograms. The latter, along with CRP and D-dimer assays, may represent useful parameters to consider when planning patient management because they appear indicative of the need for surgical treatment.
Department of Maternal and Child Health, OB/GYN Unit, University of Parma, Parma, Italy. titosilvio.patrelli@gmail.com
Tito Silvio
TS
Patrelli
Laura
L
Franchi
Salvatore
S
Gizzo
Maria Antonietta
MA
Salvati
Roberto
R
Berretta
Giovanni
G
Piantelli
Alberto Bacchi
AB
Modena
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control*; D007558:Italy; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein