April 26th, 2018

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Can the Impact of Pelvic Inflammatory Disease on Fertility Be Prevented? Epidemiology, Clinical Features and Surgical Treatment: Evolution Over 8 Years
Authors:  Tito Silvio Patrelli, M.D., Laura Franchi, M.D., Salvatore Gizzo, M.D., Maria Antonietta Salvati, M.D. Roberto Berretta, M.D., Ph.D., Giovanni Piantelli, M.D., and Alberto Bacchi Modena, M.D.
  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.

STUDY DESIGN: 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.

CONCLUSION: 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.
Keywords:  diagnosis, epidemiology, fertility, fertility impairing surgery, fertility sparing surgery, oophoritis, ovaritis, pelvic inflammatory disease, peritonitis, salpingitis, treatment
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