Inflammation of the pelvic organs. Ultrasound of the pelvic organs (OMT): how is the diagnosis made, what does the ultrasound examination Diagnosis of inflammatory diseases of the pelvic organs

One of the most common gynecological pathologies is pelvic inflammatory disease in women. Pelvic inflammatory disease is diagnosed annually in every three hundred women. About 15% of women with this diagnosis may become infertile. Most often, this pathological condition is provoked by a sexually transmitted infection: chlamydia and gonorrhea. Young women who have not managed to cross the twenty-five-year milestone and are promiscuous are at the greatest risk of getting sick.

Gynecologists distinguish the following symptoms of pelvic inflammatory disease in women:

If a woman does not pay attention to the primary symptoms, the situation may worsen and develop into a more severe form that will be difficult to treat.

Many inflammatory symptoms are unbearable and debilitating. The patient becomes difficult to carry out daily activities, work or study. Against the background of fatigue and weakness, the body temperature rises. Irritability and tearfulness appear, the menstrual cycle is disturbed.

The main provoking factors

Pelvic inflammation is provoked by:

• frequent change of sexual partners;
• difficult childbirth and pregnancy;
• prolonged wearing of the uterine spiral;
• uterine scraping;
• intrauterine interventions;
• termination of pregnancy for 12-24 months.

Another provoking factor is non-compliance with the rules of personal hygiene. This applies to women who use other people's towels, carelessly refer to public toilets and rarely wash themselves during menstruation.

The main infectious pathogens of the pathological condition include gram-negative enterobacteria, staphylococci, anaerobic microorganisms, Escherichia coli, enterococci, mycoplasmas, Proteus and streptococci.

What are the complications

Due to incorrect or untimely therapy, such a dangerous complication develops as a violation of the patency and elasticity of the uterine tubes. Some women become infertile. The risk of infertility increases with each subsequent inflammatory episode.

The danger of an ectopic pregnancy lies in the destruction of the walls of the uterine tube. This process is accompanied by severe pain. Internal bleeding occurs, which can lead to the death of a woman. A less serious consequence is chronic pelvic pain syndrome. It has been present for several years.

The main forms of pathology

Gynecologists distinguish the following inflammatory processes:

• oophoritis;
• salpingitis;
• vaginitis;
• pelvioperitonitis;
• parametritis;
• vaginosis;
• bartholinitis.

Oophoritis is an inflammatory process that affects the ovaries. Its course is combined with salpingitis or. It is acute, subacute and chronic. The main symptoms are excruciating pain in the groin, lower abdomen and lower back. The acute form is characterized by fever, chills, the presence of severe pain in the abdomen, as well as intoxication of the body.

With vaginitis, the lining of the vagina becomes inflamed. The pathological process develops against the background of the penetration of protozoa and bacteria into the body. It is characterized by a painful burning sensation in the genitals. The acute form is characterized by symptoms such as copious discharge with the smell of rotten fish and pain.

When inflammation affects the serous cover of the pelvic peritoneum, a woman is diagnosed with pelvioperitonitis. This pathology is characterized by the appearance of a strong fever, which is accompanied by chills and intoxication. The abdomen swells, the muscles of the abdominal wall tense. There are so-called peritoneal symptoms or symptoms of "acute abdomen".

The inflammatory process that occurs in the external structures of the uterus and has a purulent-infiltrative character is defined as parametritis. It is a consequence of difficult childbirth, complicated abortion and gynecological surgery. At the same time, the temperature rises, the person complains of malaise and the appearance of painful sensations in the lower abdomen.

Vaginosis is provoked by an infection, but does not have an inflammatory nature. This disease is characterized by pain during intercourse, vaginal dryness, spasms and a decrease in lactoflora. Sometimes with vaginosis, it is completely absent.

With inflammation of the large gland of the vaginal vestibule, bartholinitis is diagnosed. This pathological process develops in women older than 20 years. Today, every fiftieth woman is diagnosed with such a diagnosis.

How can you help

If acute inflammation is diagnosed, the woman is shown hospitalization in a hospital. The patient is assigned strict bed rest. The patient undertakes to adhere to a sparing diet. The activity of her intestines is under strict medical supervision. Sometimes the patient's condition involves the appointment of cleansing non-cold enemas.

Medicines such as Metronidazole, Clindamycin, Tinidazole are prescribed. Valerian and bromine preparations bring great benefits to the body. Also, the patient may be prescribed the use of sedative drugs.

When the doctor resorts to conservative therapy, he prescribes the passage for the patient:

• symptomatic treatment;
• immunotherapy;
• anticoagulant treatment;
• detox treatment;
• antibacterial treatment.

Also, violations of metabolic processes are corrected. Some cases require immediate surgical intervention. The operation is prescribed in the presence of a tubo-ovarian abscess and when the disease "does not respond" to antimicrobial drugs.

A woman should carefully monitor compliance with the rules of intimate hygiene. Turning to the doctor, she is obliged to indicate each “suspicious” sign. This will help to correctly diagnose the pathology. The sexual partner must also undergo treatment.

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to give to infants? How can you bring down the temperature in older children? What medicines are the safest?

The inflammatory process of the pelvic organs implies not one specific disease, but a group of pathological currents in the body. These include:

• Inflammatory process of the fallopian tubes in a woman - salpingitis;
• Severe inflammation of the ovaries - oophoritis;
• Salpingoophoritis is an inflammatory process of the uterus, fallopian tubes and ovaries;
• Vaginitis (colpitis) - an inflammatory process in the mucous membrane of the vagina;
• - a pathology in which there is inflammation of the entrance (vestibule) of the vagina;
• Vaginosis caused by the penetration of pathogenic bacteria into the vagina;
• Parametritis is an inflammatory process of periuterine tissue;
• Inflammatory process of the abdominal cavity called pelvioperitonitis.

All these pathologies are classified as severe acute inflammatory processes of the pelvic organs. Each of these pathologies has its own consequences, which affect the general well-being of a woman, reproductive function, sex life, etc.

Symptoms of inflammatory processes

If you experience at least one of the following symptoms, this means that you need to urgently contact your doctor. In no case is self-medication or ignoring the disease allowed. The consequences of untreated inflammatory processes of the pelvic organs can indeed be extremely severe, ranging from a violation menstrual cycle ending in infertility.

We list the main symptoms inflammatory diseases pelvic organs:

Concomitant symptoms of the inflammatory process are irregular periods in women or a complete violation of the menstrual cycle. In this case, there may be pain during urination, pain in the urethra. Against the background of general malaise, a woman may experience a gag reflex, diarrhea, diarrhea. Physical state of fatigue, weakness, fever.

Causes of the inflammatory process

Why can a woman develop inflammatory processes in the vagina? Let's look at the main reasons for this phenomenon.

The inflammatory process may begin to develop after a recent surgical abortion, difficult childbirth (with complications). In some cases, the infection can enter the vagina from an inflamed, infected appendix, from an affected rectum.

Such a pathological course as vulvitis appears due to mechanical damage (this may be vaginal scratching due to severe itching, as a result - the appearance of abrasions, scratching). As you know, an infection penetrates into an open wound faster and affects the surrounding tissues.

Endometritis, which is classified as an acute inflammatory process in the uterine mucosa, appears in a woman after a medical or surgical abortion, curettage of the uterine mucosa for medical reasons.

Factors affecting the occurrence of the inflammatory process

The main factors that affect the course of the inflammatory process are:

• Carrying out several abortions within 1-2 years;
• Intrauterine interventions;
• Prolonged wearing of an intrauterine device;
• Surgical;
• Constant change of sexual partners;
• Previously untreated inflammatory processes of the pelvic organs;
• Severe labor activity;
• Violation of the rules of personal hygiene (use of other people's towels, soap, infrequent washing during the day).

Diagnostics of the inflammatory process of the uterus

If you experience unpleasant symptoms in the genital area of ​​a woman, it is necessary to consult a gynecologist as soon as possible. Do not delay with this, otherwise it can lead to serious consequences in the form of infertility.

An experienced gynecologist can determine the presence of an inflammatory process in a patient during a routine examination and questioning of symptoms. When the doctor begins to touch the uterus, pain may occur, which is quite difficult for a woman to endure.

To confirm the presence of an inflammatory process, it will be necessary to pass smears of mucus from the vagina, as well as the cervix. During an infectious-inflammatory process in a woman in the vaginal mucus, causative agents of the disease will be found - viruses, infections, fungal microorganisms, trichomonas, gonococci, ureplasma, mycoplasma, E. coli and not only.

You will also need to take a blood test - according to the results of the analysis, leukocytosis will be detected in the inflammatory process. According to an ultrasound study, the patient will find a pathological increase in the ovaries, the size of the appendages, as well as the formation of foci of purulent accumulation, infection and inflammation.

Treatment of the inflammatory process in the vagina

If the patient is diagnosed with vulvovaginitis, then the treatment will be exclusively outpatient. If the inflammatory process proceeds in a mild form, then in this case, treatment can proceed at home with the help of drug therapy.

To eliminate the inflammatory process, the most commonly used drugs are Metronidazole, Clindamycin, Tinidazole. If a woman has inflammation in the vagina, her partner must also undergo treatment, otherwise such therapy will not make sense.

Obstetrician-gynecologists have found that in 80% of women, pain in the lower abdomen is associated with local varicose veins. Stagnation of blood in the small pelvis causes a number of painful manifestations in men. The organs located in this zone perform different functions, but are interconnected by a common blood circulation. Therefore, the disease of one can quickly spread to neighboring areas.

Treatment will not positive results without restoration of outflow of venous blood.

What is the "small pelvis" and what is in it?

"Pelvis" is called anatomical bone formation. In front, it is represented by the pubic bones, behind - by the sacrum and coccyx, on the sides - by the lower part of the ilium. Vertically, one can distinguish between the entrance at the level of the sciatic joint and the outlet formed by the coccyx, ischial tuberosities, and the lower branches of the pubic joint.

The bone frame is designed to protect the organs lying inside. In both sexes, the rectum is located here. Its task: the accumulation and removal of waste slag from the body. She lies directly on the sacrum. It has a length of up to 15 cm in an adult and stretches in diameter up to 8 cm.

The bladder lies behind fatty tissue and pubic bones. When overflowing, the top edge protrudes above the articulation.

Among women

In the small pelvis are located:

• ovaries - the place where eggs mature, sex hormones are produced and enter the bloodstream;
• uterus - an unpaired organ, similar to a pear, located tail down, lies between the bladder and the rectum, narrows below and passes into the cervix and vagina;
• vagina - has the shape of a tube up to 10 cm long, connects the genital gap and the cervix.

In men

The male organs in the pelvis are:

• prostate gland - produces a secret that is part of the sperm, located below the bladder;
• seminal vesicle - length 5 cm, width 2 cm, secretory organ, through the ejaculatory duct brings its product out.

All organs are supported by dense ligaments of connective tissue.

Features of the blood supply

Arterial blood comes from the abdominal aorta through the iliac arteries. The veins accompany the arteries, run parallel, and form venous plexuses around each organ. An important feature of local venous blood flow:

• a wide network of anastomoses, through which, on the one hand, an auxiliary outflow is provided in case of thrombosis, on the other hand, the infection quickly spreads between adjacent anatomical formations;
• unlike the veins of the limbs, the vessels do not have a valve apparatus, which causes rapid stagnation of blood in the pelvic organs;
• venous trunks located along the bone skeleton are tightly tied to the walls of the pelvis, therefore, in case of bone injuries, they do not collapse, but are wide open, which contributes to blood loss.

Why is there stagnation?

The causes of stagnation of blood in the veins of the pelvis are associated with damage to the vascular wall or a mechanical obstacle to blood flow:

• varicose veins - occurs due to a violation of the structure, elasticity, loss of hyaluronic acid by cells, hereditary predisposition;
• alcoholism and nicotine addiction- both factors destroy hyaline, cause varicose veins;
• violation of the central regulation of blood vessels, spasm, turning into a loss of tone in diseases of the nervous system;
• prolonged sitting position at work, lack of movement during the day;
• irrational diet, passion for various diets that cause beriberi, constipation;
• for women, pregnancy, bending of the uterus and taking hormonal contraceptives are important.

Wearing tight underwear, corsets, belts, prevents the outflow of venous blood, the pursuit of beauty leads to pathology

Clinical manifestations

The symptoms caused by blood stasis are not typical, since they are also found in other diseases. But they should be remembered in the differential diagnosis of diseases.

Both men and women complain about the following:

• pain in the lower abdomen is long-lasting, aching or sharp, stabbing, radiating to the lower back, thigh, perineum;
• feeling of heaviness.

Accompanying various diseases, circulatory pathology manifests itself in different ways:

• stagnation of blood in the pelvis in women and men causes infertility;
• as one of the causes of inflammatory diseases in men, urethritis develops, prostatitis with pain during urination, pain in the perineum, impotence;
• varicocele as a variant of varicose veins in men causes an increase in the testicle on the one hand, pain;
• in women, uterine prolapse occurs, the menstrual cycle is disturbed, bleeding intensifies;
• chronic hemorrhoids with pain in anus, burning and itching.

With a long course of the disease, general symptoms are observed regarding changes in the mental state of a person: depression or anxiety, irritability, tearfulness appear.

Diagnostics

If congestion in the small pelvis is suspected, doctors use hardware examination methods to confirm or remove the diagnosis:

• Ultrasound - assesses the size of organs and the state of blood flow;
• phlebography - introduced contrast agent into the inguinal vein followed by an x-ray, the procedure has a risk of an allergic reaction to the drug;
• computed tomography - allows you to identify local varicose veins;
• magnetic resonance imaging - reveals signs of inflammation, changes in the location and shape of the pelvic organs, the structure and direction of blood vessels.

Treatment Requirements

The complex of treatment necessarily, in addition to drug therapy, includes gymnastic exercises, diet. It is necessary to achieve normalization of sleep, quit smoking, limit the use of alcoholic beverages.

In the diet, you need to include everything that prevents stool retention: liquid up to 2 liters per day, vegetables and fruits, dairy products, exclude sweets, fried and spicy foods. Replace fatty meat products with fish and poultry meat. In connection with the increased gas formation, it is better to exclude dishes from legumes and cabbage.

What exercises can you do at home?

• swimming;
• jogging;
• jumping rope;
• yoga.

This physical activity simultaneously trains the heart and vascular function.

At home, you should spend 15 minutes daily therapeutic gymnastics. Exercises shown:

1. in the supine position on the mat, make circles with your feet as when riding a bicycle, alternate movements forward and backward;
2. static exercises for the lower abdominal muscles - while lying down, lift and pull the pelvis towards you, hold in this position for 15–20 seconds, catch your breath and repeat 3 sets;
3. stand on the shoulder blades;
4. imitate the position of a half-squat so that the thigh and lower leg make an angle of 90 degrees, hold for a minute.

The use of medicines

Medicines that normalize the outflow of blood can only be prescribed by a doctor after a complete examination. The following medicines are used:

• Venza - a drug in drops, relieves tissue swelling, increases the tone of the vascular wall.
• Aescusan - drops of tonic action.
• Askorutin - a complex preparation of ascorbic acid and rutin, has a rejuvenating and antioxidant effect, normalizes cellular metabolism in the area of ​​stagnation, and is a means of preventing inflammation.

Treatment with folk remedies

Treatment uses the following folk recipes that improve pelvic circulation:

1. a decoction of hawthorn fruits, dried raspberries, wild rose, motherwort, calendula flowers with the addition of orange peel. Brew for half an hour, drink as tea three times a day;
2. a combination of licorice root, aralia, succession, elecampane, wild rose, field horsetail in equal amounts insist in a thermos overnight, drink ½ cup before meals;
3. collection of thyme, calamus root, nettle, buckthorn bark, coltsfoot leaves boil for 5 minutes in an enamel bowl or brew in a thermos overnight, drink 100 ml three times.

Apply herbal preparations with breaks of 2 weeks

When is surgery needed?

The use of surgical methods is recommended in case of ineffective conservative treatment. Most often, operations are performed using endoscopic techniques. A laparoscope with a microcamera is inserted through small skin incisions, the organs are examined, dilated vessels are found and bandaged.

How to prevent stagnation?

Prevention in the pelvic organs includes:

• quitting smoking and excessive consumption of alcoholic beverages and beer;
• observance of an active motor mode, walking, physical activities, sports;
• adhering to reasonable measures in the diet for the use of fatty foods, limiting food processing by frying and sweets;
• control over the amount of fluid drunk;
• organization of the work regime with the provision of rest and warm-up to the muscles every 2 hours.

Indispensable conditions include timely access to a doctor and treatment of inflammatory diseases of the genital area, hemorrhoids. This will eliminate unnecessary infectious components, prevent phlebitis and pelvic vein thrombosis.

Inflammatory diseases of the pelvic organs (PID) are characterized by various manifestations depending on the level of the lesion and the strength of the inflammatory reaction. The disease develops when the pathogen enters the genital tract (enterococci, bacteroids, chlamydia, mycoplasmas, ureaplasmas, Trichomonas) and in the presence of favorable conditions for its development and reproduction. These conditions occur during the postpartum or post-abortion period, during menstruation, with various intrauterine manipulations (IUD insertion, hysteroscopy, hysterosalpingography, diagnostic curettage).

Existing natural defense mechanisms, such as anatomical features, local immunity, the acidic environment of the vaginal contents, the absence of endocrine disorders or serious extragenital diseases, can in the vast majority of cases prevent the development of a genital infection. In response to the invasion of one or another microorganism, an inflammatory response occurs, which, based on the latest concepts of the development of the septic process, is usually called the "systemic inflammatory response".

Acute endometritis always requires antibiotic therapy. The inflammatory process affects the basal layer of the endometrium due to the invasion of specific or nonspecific pathogens. Endometrial defense mechanisms, congenital or acquired, such as T-lymphocyte aggregates and other elements of cellular immunity, are directly related to the action of sex hormones, especially estradiol, act in conjunction with the macrophage population and protect the body from damaging factors. With the onset of menstruation, this barrier on a large surface of the mucous membrane disappears, which makes it possible to become infected. Another source of protection in the uterus is the infiltration of the underlying tissues with polymorphonuclear leukocytes and a rich blood supply to the uterus, which contributes to adequate perfusion of the organ with blood and non-specific humoral defense elements contained in its serum: transferrin, lysozyme, opsonins.

The inflammatory process can also spread to the muscle layer: then metroendometritis and metrothrombophlebitis occur with a severe clinical course. The inflammatory reaction is characterized by a disorder of microcirculation in the affected tissues, pronounced exudation, with the addition of anaerobic flora, necrotic destruction of the myometrium may occur.

Clinical manifestations of acute endometritis are characterized already on the 3rd-4th day after infection by an increase in body temperature, tachycardia, leukocytosis and an increase in ESR. A moderate increase in the uterus is accompanied by pain, especially along its ribs (along the course of the blood and lymphatic vessels). Purulent-bloody discharges appear. The acute stage of endometritis lasts 8-10 days and requires quite serious treatment. At proper treatment the process ends, rarely goes into subacute and chronic forms, even more rarely, with independent and indiscriminate antibiotic therapy, endometritis can take a milder abortive course.

Treatment of acute endometritis, regardless of the severity of its manifestations, begins with antibacterial infusion, desensitizing and restorative therapy.

Antibiotics are best prescribed taking into account the sensitivity of the pathogen to them. Doses and duration of antibiotic use are determined by the severity of the disease. Due to the frequency of anaerobic infection, the additional use of metronidazole is recommended. Considering the very rapid course of endometritis, cephalosporins with aminoglycosides and metronidazole are preferable among antibiotics. For example, cefamandole (or cefuroxime, cefotaxime) 1.0-2.0 g 3-4 times a day IM or IV drip + gentamicin 80 mg 3 times a day IM + Metrogyl 100 ml IV / in drip.

Instead of cephalosporins, semi-synthetic penicillins can be used (with an abortive course), for example, ampicillin 1.0 g 6 times / day. The duration of such combined antibiotic therapy depends on the clinic and laboratory response, but should not be less than 7-10 days. As a prevention of dysbacteriosis from the first days of antibiotic treatment, nystatin 250,000 IU 4 times a day or Diflucan 50 mg / day for 1-2 weeks orally or intravenously is used.

Detoxification infusion therapy may include a number of infusion agents, for example, Ringer-Locke solution - 500 ml, polyionic solution - 400 ml, gemodez (or polydez) - 400 ml, 5% glucose solution - 500 ml, 1% calcium chloride solution - 200 ml, Unithiol with 5 % solution of ascorbic acid, 5 ml 3 times / day. In the presence of hypoproteinemia, it is advisable to carry out infusions of protein solutions (albumin, protein), blood-substituting solutions, plasma, erythrocyte mass or whole blood, amino acid preparations.

Physiotherapy treatment is one of the leading places in the treatment of acute endometritis. It not only reduces the inflammatory process in the endometrium, but also stimulates ovarian function. When the temperature reaction is normalized, it is advisable to prescribe low-intensity ultrasound, inductothermy electromagnetic field HF or UHF, magnetotherapy, laser therapy.

Every fifth woman who has undergone salpingo-oophoritis is at risk of infertility. Adnexitis may be the cause high risk ectopic pregnancy and pathological course of pregnancy and childbirth. The fallopian tubes are the first to be affected, while the inflammatory process can cover all layers of the mucous membrane of one or both tubes, but more often only the mucous membrane of the tube is affected, catarrhal inflammation of the mucous membrane of the tube occurs - endosalpingitis. Inflammatory exudate, accumulating in the tube, often flows out through the ampullary opening into the abdominal cavity, adhesions form around the tube and the abdominal opening of the tube closes. A saccular tumor develops in the form of a hydrosalpinx with transparent serous contents or in the form of a pyosalpinx with purulent contents. In the future, the serous exudate of the hydrosalpinx resolves as a result of treatment, and the purulent pyosalpinx can perforate into the abdominal cavity. The purulent process can capture and melt everything large areas small pelvis, spreading to all internal genitalia and nearby organs.

Inflammation of the ovaries (oophoritis) as the primary disease is rare, infection occurs in the region of the ruptured follicle, since the rest of the ovarian tissue is well protected by the overlying germinal epithelium. In the acute stage, edema and small cell infiltration are observed. Sometimes in the cavity of the follicle of the corpus luteum or small follicular cysts, abscesses, microabscesses are formed, which, merging, form an ovarian abscess or pyovarium. In practice, it is impossible to diagnose an isolated inflammatory process in the ovary, and this is not necessary. Currently, only 25-30% of patients with acute adnexitis have a pronounced picture of inflammation, in the remaining patients there is a transition to a chronic form, when therapy is stopped after a rapid subsidence of the clinic.

Acute salpingoophoritis it is also treated with antibiotics (preferably third-generation fluoroquinolones - Ciprofloxacin, Tarivid, Abaktal), since it is often accompanied by pelvioperitonitis - inflammation of the pelvic peritoneum.

Inflammation of the pelvic peritoneum occurs most often secondary to the penetration of infection into the abdominal cavity from an infected uterus (with endometritis, infected abortion, ascending gonorrhea), from the fallopian tubes, ovaries, from the intestines, with appendicitis, especially with its pelvic location. In this case, an inflammatory reaction of the peritoneum is observed with the formation of a serous, serous-purulent or purulent effusion. The condition of patients with pelvioperitonitis remains either satisfactory or moderate. The temperature rises, the pulse quickens, but the function of cardio-vascular system is little disturbed. With pelvioperitonitis, or local peritonitis, the intestines remain not swollen, palpation of the upper half of the abdominal organs is painless, and symptoms of peritoneal irritation are determined only above the womb and in the iliac regions. However, patients report severe pain in the lower abdomen, there may be a delay in stool and gases, sometimes vomiting. The level of leukocytes is increased, the shift of the formula to the left, the ESR is accelerated. Gradually increasing intoxication worsens the condition of patients.

Treatment of salpingo-oophoritis with or without pelvioperitonitis begins with a mandatory examination of the patient for flora and sensitivity to antibiotics. The most important thing is to determine the etiology of inflammation. To date, benzylpenicillin is widely used to treat a specific gonorrheal process, although drugs such as Rocephin, Cefobid, Fortum are preferable.

The "gold standard" in the treatment of salpingo-oophoritis from antibiotic therapy is the appointment of Klaforan (cefotaxime) at a dose of 1.0-2.0 g 2-4 times / day / m or a single dose of 2.0 g / in combination with gentamicin 80 mg 3 times / day (gentamicin can be administered once at a dose of 160 mg / m). Be sure to combine these drugs with the introduction of Metrogyl / in 100 ml 1-3 times / day. The course of antibiotic treatment should be carried out for at least 5-7 days, prescribing cephalosporins of the II and III generations (Mandol, Zinacef, Rocefin, Cefobid, Fortum and others at a dose of 2-4 g / day).

In case of acute inflammation of the uterine appendages, complicated by pelvioperitonitis, oral administration of antibiotics is possible only after the main course, and, moreover, if necessary. As a rule, there is no such need, and the persistence of the previous clinical symptoms may indicate the progression of inflammation and a possible suppurative process.

Detoxification therapy is mainly carried out with crystalloid and detoxification solutions in the amount of 2-2.5 liters with the inclusion of Hemodez, Reopoliglyukin, Ringer-Locke solutions, polyionic solutions - acessol, etc. Antioxidant therapy is carried out with Unithiol solution 5.0 ml with 5% ascorbic acid solution 3 times / day in / in.

In order to normalize the rheological and coagulation properties of blood and improve microcirculation, they use acetylsalicylic acid(Aspirin) 0.25 g / day for 7-10 days, as well as the / in the introduction of Reopoliglyukin 200 ml (2-3 times per course). In the future, a whole complex of resolving therapy and physiotherapeutic treatment is used (calcium gluconate, autohemotherapy, sodium thiosulfate, Humisol, Plasmol, Aloe, FiBS). Of the physiotherapeutic procedures in an acute process, ultrasound is appropriate, which provides analgesic, desensitizing, fibrolytic effects, increased metabolic processes and tissue trophism, inductothermy, UHF therapy, magnetotherapy, laser therapy, and later - spa treatment.

Among 20-25% of inpatients with inflammatory diseases of the uterine appendages, 5-9% have purulent complications that require surgical interventions.

We can distinguish the following provisions regarding the formation of purulent tubo-ovarian abscesses:

• chronic salpingitis in patients with tubo-ovarian abscesses is observed in 100% of cases and precedes them;
• the spread of the infection goes mainly by the intracanalicular route from endometritis (with IUD, abortion, intrauterine interventions) to purulent salpingitis and oophortiu;
• frequent combination of cystic changes in the ovaries with chronic salpingitis;
• there is a mandatory combination of ovarian abscesses with exacerbation of purulent salpingitis;
• ovarian abscesses (pyovarium) are formed mainly from cystic formations, often microabscesses merge with each other.

Morphological forms of purulent tubo-ovarian formations:

• pyosalpinx - a predominant lesion of the fallopian tube;
• pyovarium - predominant lesion of the ovary;
• tubo-ovarian tumor.

All other combinations are complications of these processes and can occur:

• without perforation;
• with perforation of abscesses;
• with pelvioperitonitis;
• with peritonitis (limited, diffuse, serous, purulent);
• with pelvic abscess;
• with parametritis (rear, anterior, lateral);
• with secondary lesions of adjacent organs (sigmoiditis, secondary appendicitis, omentitis, interintestinal abscesses with fistula formation).

It is practically impossible and inexpedient to clinically differentiate each of these localizations, since the treatment is fundamentally the same, antibiotic therapy occupies a leading position both in terms of the use of the most active antibiotics and the duration of their use. At the heart of purulent processes is the irreversible nature of the inflammatory process. Irreversibility is due to morphological changes, their depth and severity, often associated with severe impairment of kidney function.

Conservative treatment of irreversible changes in the uterine appendages is unpromising, since if it is carried out, it creates the prerequisites for the emergence of new relapses and aggravation of disturbed metabolic processes in patients, increases the risk of the upcoming operation in terms of damage to adjacent organs and the inability to perform the required amount of surgery.

Purulent tubo-ovarian formations are a difficult process in diagnostic and clinical terms. Nevertheless, a number of characteristic syndromes can be distinguished:

• intoxication;
• painful;
• infectious;
• early renal;
• hemodynamic disorders;
• inflammation of adjacent organs;
• metabolic disorders.

Clinically, the intoxication syndrome manifests itself in intoxication encephalopathy, headaches, heaviness in the head and heaviness general condition. There are dyspeptic disorders (dry mouth, nausea, vomiting), tachycardia, sometimes hypertension (or hypotension with incipient septic shock, which is one of its early symptoms along with cyanosis and flushing of the face against a background of severe pallor).

The pain syndrome is present in almost all patients and is of an increasing nature, accompanied by a deterioration in the general condition and well-being, there is pain during a special study, displacement beyond the cervix and symptoms of peritoneal irritation around the palpable formation. Pulsating growing pain, persistent fever with body temperature above 38°C, tenesmus, loose stools, lack of clear tumor contours, lack of effect from treatment - all this indicates the threat of perforation or its presence, which is an absolute indication for urgent surgical treatment . The infectious syndrome is present in all patients, manifesting in most patients with high body temperature (38 ° C and above), tachycardia corresponds to fever, as well as an increase in leukocytosis, ESR and leukocyte intoxication index increase, the number of lymphocytes decreases, white blood shift to the left and the number molecules of medium weight, reflecting the growing intoxication. Often there is a change in kidney function due to a violation of the passage of urine. Metabolic disorders are manifested in dysproteinemia, acidosis, electrolyte imbalance, etc.

The treatment strategy for this group of patients is based on organ-preserving principles of operations, but with a radical removal of the main focus of infection. Therefore, for each specific patient, the volume of the operation and the time of its implementation should be optimal. Clarification of the diagnosis sometimes takes several days - especially in cases where there is a borderline variant between suppuration and an acute inflammatory process or in differential diagnosis from an oncological process. At each stage of treatment, antibiotic therapy is required.

Preoperative therapy and preparation for surgery include:

• antibiotics (using Cefobid 2.0 g / day, Fortum 2.0-4.0 g / day, Reflin 2.0 g / day, Augmentin 1.2 g IV drip 1 time / day, Clindamycin 2.0- 4.0 g/day, etc.). They must be combined with gentamicin 80 mg intramuscularly 3 times / day and Metrogyl infusion 100 ml intravenously 3 times;
• detoxification therapy with infusion correction of volemic and metabolic disorders;
• mandatory assessment of the effectiveness of treatment in terms of body temperature, peritoneal symptoms, general condition and blood counts.

The surgical phase also includes ongoing antibiotic therapy. It is especially valuable to introduce one daily dose of antibiotics on the operating table immediately after the end of the operation. This concentration is necessary as a barrier to the further spread of infection, since dense purulent capsules of tubo-ovarian abscesses no longer prevent penetration into the inflammation zone. Beta-lactam antibiotics (Cefobide, Rocefin, Fortum, Klaforan, Tienam, Augmentin) pass these barriers well.

Postoperative therapy includes continuation of antibiotic therapy with the same antibiotics in combination with antiprotozoal, antimycotic drugs and uroseptics in the future (according to sensitivity). The course of treatment is based on the clinical picture, laboratory data, but should not be less than 7-10 days. The cancellation of antibiotics is carried out according to their toxic properties, so gentamicin is often canceled first, after 5-7 days, or replaced by amikacin.

Infusion therapy should be aimed at combating hypovolemia, intoxication and metabolic disorders. It is very important to normalize the motility of the gastrointestinal tract (intestinal stimulation, HBO, hemosorption or plasmapheresis, enzymes, epidural blockade, gastric lavage, etc.). Hepatotropic, restorative, antianemic therapy is combined with immunostimulating therapy (UVI, laser blood irradiation, immunocorrectors).

All patients who underwent surgery for purulent tubo-ovarian abscesses need post-hospital rehabilitation in order to prevent relapses and restore specific body functions.

Literature

1. Abramchenko V. V., Kostyuchek D. F., Perfilyeva G. N. Purulent-septic infection in obstetric and gynecological practice. SPb., 1994. 137 p.
2. Bashmakova M. A., Korkhov V. V. Antibiotics in obstetrics and perinatology. M., 1996. No. 9. S. 6.
3. Bondarev N. E. Optimization of diagnosis and treatment of mixed sexually transmitted diseases in gynecological practice: Ph.D. dis. … cand. honey. Sciences. SPb., 1997. 20 p.
4. Venzela R. P. Nosocomial infections // M., 1990. 656 p.
5. Gurtovoy B. L., Serov V. N., Makatsaria A. D. Purulent-septic diseases in obstetrics. M., 1981. 256 p.
6. Keith L. G., Berger G. S., Edelman D. A. Reproductive health: Vol. 2 // Rare infections. M., 1988. 416 p.
7. Krasnopolsky V.I., Kulakov V.I. Surgical treatment of inflammatory diseases of the uterine appendages. M., 1984. 234 p.
8. Korkhov V. V., Safronova M. M. Modern approaches to the treatment of inflammatory diseases of the vulva and vagina. M., 1995. No. 12. S. 7-8.
9. Kyumerle H. P., Brendel K. Clinical pharmacology during pregnancy / ed. X. P. Kyumerle, K. Brendel: trans. from English. T. 2. M., 1987. 352 p.
10. Serov V. N., Strizhakov A. N., Markin S. A. Practical obstetrics: a guide for physicians. M., 1989. 512 p.
11. Serov V. N., Zharov E. V., Makatsaria A. D. Obstetric peritonitis: diagnosis, clinic, treatment. M., 1997. 250 p.
12. Strizhakov A. N., Podzolkova N. M. Purulent inflammatory diseases of the uterine appendages. M., 1996. 245 p.
13. Khadzhieva E. D. Peritonitis after caesarean section: a study guide. SPb., 1997. 28 p.
14. Sahm D.E. The role of automation and molecular technology in antimicrobial suscepibility testing // Clin. Microb. And Inf. 1997; 3:2(37-56).
15. Snuth C. B., Noble V., Bensch R. et al. Bacterial flora of the vagina during the mensternal cycle // Ann. Intern. Med. 1982; p. 948-951.
16. Tenover F.C. Norel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens // Am. J. Med. 1991; 91, p. 76-81.

V. N. Kuzmin, doctor of medical sciences, professor
MGMSU, Moscow

Causes of the disease of the pelvic organs

Promiscuous sexual intercourse leading to infection with sexually transmitted diseases:

General fatigue, weakness.

Acute onset of an infectious inflammatory process is rare. Usually, there is a gradual development of the inflammatory process, without pronounced clinical manifestations, which leads to the chronic form of the disease. Therefore, laboratory instrumental diagnostic methods are the main ones in determining this group of diseases.

Laboratory and instrumental research

In the diagnosis of PID, great importance is attached to bacteriological methods and PCR to determine pathogens, their number, hysteroscopy and laparoscopy, pathomorphological examination. All symptoms of pelvic inflammatory disease can be divided into: minimal, additional and reliable criteria.

Minimum clinical criteria:

pain on palpation in the lower abdomen;
pain in the appendages.
pain when pressing on the cervix.

In the presence of these signs and the absence of any other cause of the disease, it is necessary to conduct a trial treatment for PID in all sexually active young women of reproductive age.

Additional criteria (to increase the specificity of diagnosis):

Body temperature above 38.0 gr.
abnormal discharge from the cervix or vagina
complete blood count - leukocytosis, a change in the leukocyte formula (shift to the left), an increase in ESR and the content of C-reactive protein
laboratory confirmation of cervical infection caused by gonococci, trichomonas, chlamydia.

Reliable criteria:

microscopic confirmation of endometritis by endometrial biopsy. This method is carried out using endoscopic equipment that allows you to enter the uterine cavity (performed through the vagina and cervix) and take a small section of the endometrium for microscopy.

Thickening of the fallopian tubes, the presence of free fluid in the abdominal cavity according to ultrasound.

Laparoscopic confirmation of the inflammatory local process.

However, it should be noted that it is impossible to make a final diagnosis only on the basis of the results of one of the necessary studies - the examination must be comprehensive.

Treatment

Stages of treatment of inflammatory diseases of the pelvic organs

First - elimination of the provoking factor, since in the presence of a damaging agent, inflammation is not completely eliminated. Therefore, there is no restoration of the anatomical and functional damaged organ (uterus, ovary, fallopian tube).

Second - restoration of the physiological state of the damaged organ and organs surrounding it and elimination of the consequences of secondary damage (restoration of blood circulation, anatomical location, ability to hormonal regulation of function).

Non-drug treatment

Traditionally, in the complex therapy of PID, physiotherapy is used, in particular, preformed currents. Having a beneficial effect on the local circulation of the pelvic organs, regeneration processes, endometrial receptor activity, electrotherapy helps in eliminating the clinical symptoms of the disease and restoring the tissue structure.

Medical therapy

Antibacterial therapy

Treatment regimens for PID should address a wide range of potential pathogens. In addition, it is necessary to take into account the possible resistance of microorganisms to traditional antibiotics. Due to the fact that practically no antibiotic is active against all PID pathogens, their choice in such cases is based on the combined use of drugs in order to cover the spectrum of the main (13 including resistant) pathogens. For this purpose, a combination of several antibiotics is used.

Enzyme therapy

Preparations of proteolytic enzymes enhance the effect of antibiotics. One of the representatives of enzyme preparations is Wobenzym, which is prescribed in conjunction with antibacterial treatment.

Immunomodulating therapy

Do not rely solely on a miraculous cure for infection through the use of antibiotics. An important aspect of the treatment of chronic infectious diseases is the stimulation of immune protective properties organism. Immunomodulatory therapy is carried out taking into account the results of an immunological study.

Indications for immunomodulatory therapy:

Prolonged course of chronic recurrent inflammatory process.
mixed infections (especially in the absence of the effect of previous courses of antimicrobial treatment).

In order to correct immunity, drugs such as immunomax, cycloferon, licopid are prescribed.

Metabolism modulation It is aimed at enhancing tissue metabolism and eliminating the consequences of hypoxia. For this purpose, drugs such as actovegin, E, ascorbic acid, methionine, glutamic acid are prescribed.

Criteria for the effectiveness of the treatment- elimination of the clinical symptoms of the disease, restoration of the normal structure of the endometrium, destruction or decrease in the activity of the infectious agent, restoration of the morphological structure of the uterus and internal genital organs of a woman. Establishing regular menstruation and ovulation.

In order to assess the adequacy of therapeutic measures, it is mandatory to conduct regular ultrasound monitoring of the dynamics of the process, as well as 2 months after the end of the course of treatment, a control morphological and bacteriological study of the endometrium of the uterus.

Pregnancy prognosis

The success of therapeutic interventions to restore reproductive function depends on the duration of the disease and the severity of structural disorders in the endometrium. After a full course of therapy in the absence of other factors for the development of infertility, the pregnancy rate reaches 80%, but 75% continue to carry the pregnancy.

At birth, a girl's vagina is sterile. Then, within a few days, it is populated by a variety of bacteria, mainly staphylococci, streptococci, anaerobes (that is, bacteria that do not require oxygen to live). Before the onset of menstruation, the acidity level (pH) of the vagina is close to neutral (7.0). But during puberty, the walls of the vagina thicken (under the influence of estrogen - one of the female sex hormones), the pH drops to 4.4 (i.e., the acidity increases), which causes changes in the vaginal flora. More than 40 types of bacteria can “live” in the vagina of a healthy non-pregnant woman. The flora of this organ is individual and changes in different phases of the menstrual cycle. The most useful microorganisms of the vaginal flora are lactobacilli. They inhibit the growth and reproduction of harmful microbes by producing hydrogen peroxide. The quality of protection they provide in this way exceeds the potential of antibiotics. The value of the normal vaginal flora is so great that doctors speak of it as a microecological system that protects all the reproductive organs of a woman.

There are two main routes of infection transmission: domestic And sexual. The first is possible if the rules of personal hygiene are not observed. However, more often infection occurs during sexual intercourse. The most common causative agents of infections of the pelvic organs are microorganisms such as gonococci, trichomonas, chlamydia. However, it is now clear that O Most of the diseases are caused by the so-called microbial associations - that is, the combination of several types of microorganisms with unique biological properties.

In the spread of infections, oral and anal sex plays an important role, in which microorganisms enter the urethra of a man and the vagina of a woman that are not characteristic of these anatomical sections and change the properties of the microecological system, which was mentioned above. For the same reason, protozoa and worms contribute to infection.

There are some risk factors in the presence of which it is easiest for microbes to "get" to the uterus and appendages. These include:

Any intrauterine interventions, such as the introduction of intrauterine devices, abortion operations;

Multiple sexual partners;

Sex without barrier methods of contraception (contraceptive pills, etc. do not protect against the transmission of infection, therefore, before conception, it is imperative to be examined to identify possible infectious diseases of the pelvic organs);

Past inflammatory diseases of the female genital organs (there remains the possibility of maintaining a chronic inflammatory process and the development of vaginal dysbacteriosis - see sidebar);

Childbirth; hypothermia (the well-known expression "cold appendages" emphasizes the connection of hypothermia with a decrease in immunity).

MANIFESTATIONS OF INFLAMMATORY DISEASES OF THE PELVIC BODIES

Diseases of the female genital organs can be asymptomatic, but in most cases a woman complains of the following:

Pain in the lower abdomen;

Vaginal discharge (their nature depends on the type of pathogen);

Fever and general malaise;

Discomfort when urinating;

irregular menstruation;

Pain during sexual intercourse.

HOW IS THE DIAGNOSIS MADE?

Making a diagnosis is not an easy task. To begin with, the results of a general blood test are evaluated. An increase in the level of leukocytes gives reason to suspect an inflammatory process. On examination, the gynecologist may reveal soreness of the cervix and ovaries. The doctor also takes vaginal swabs to look for the causative agent of the infection. In difficult cases, they resort to laparoscopy: this is a surgical intervention in which special instruments are inserted into the pelvis through small incisions in the anterior wall of the abdomen, allowing you to directly examine the ovaries, fallopian tubes and uterus.

CONSEQUENCES OF PELVIC INFLAMMATORY DISEASES

Before pregnancy. Let's start with the fact that inflammatory diseases of the female genital organs are the most common cause of infertility. The infectious process affects the fallopian tubes, they grow connective tissue, which leads to their narrowing and, accordingly, partial or complete obstruction. If the tubes are blocked, then the sperm cannot reach the egg and fertilize it. With frequently recurring inflammatory processes in the pelvic organs, the likelihood of infertility increases (after a single inflammatory disease of the pelvic organs suffered by a woman, the risk of infertility, according to statistics, is 15%; after 2 cases of the disease - 35%; after 3 or more cases - 55%).

In addition, women with a history of pelvic inflammatory disease are much more likely to develop ectopic pregnancies. This is because the fertilized egg cannot travel down the damaged tube and into the uterus for implantation. Often with tubal infertility, laparoscopic restoration of the patency of the fallopian tube is used. In difficult cases resort to in vitro fertilization.

Pregnancy. If, nevertheless, pregnancy occurred against the background of an already existing inflammatory process in the pelvic organs, then it should be borne in mind that due to a completely natural decrease in the activity of the immune system during pregnancy, the infection will certainly “raise its head” and its exacerbation will occur. Signs of exacerbation that make a woman see a doctor depend on the type of pathogen of a particular infection. Almost always concerned about pain in the abdomen, vaginal discharge (leucorrhoea). In such a situation, a pregnant woman and a doctor will have to solve a difficult question: what to do with pregnancy. The fact is that the exacerbation of the inflammatory process is fraught with the threat of abortion, such a pregnancy is always difficult to maintain. In addition, the required antibiotic treatment is not indifferent to the developing fetus. If the infection is caused by pathogenic microorganisms, especially those related to the causative agents of sexually transmitted diseases (syphilis, gonorrhea), the doctor often recommends termination of pregnancy. If there is a dysbacteriosis and a situation where opportunistic microorganisms have taken the place of the natural inhabitants of the female genital organs (see sidebar), the doctor will select a treatment based on the sensitivity of the detected pathogens to antibiotics and the duration of pregnancy.

Special mention deserves the situation when during pregnancy there is not an exacerbation of an already existing inflammatory process, but infection and the subsequent development of infection. This is often accompanied by the penetration of an infectious agent to the fetus and intrauterine infection of the latter. Now doctors can trace the development of the pathological process in the fetus; decision on necessary measures taken on a case-by-case basis.

A persistent (untreated or undertreated) infection affecting the birth canal (i.e., the cervix, vagina, and external genitalia) is fraught with infection of the child during childbirth, when a healthy baby, safely avoiding intrauterine contact with infection due to the protection of the membranes, becomes completely defenseless. In such cases, doctors often insist on a caesarean section.

Now it becomes clear why even healthy women should be examined twice during pregnancy to detect infectious diseases of the reproductive organs (examination of a smear from the vagina, and, if necessary, a blood test for the presence of antibodies to certain pathogens). And of course, it is necessary to cure the existing diseases.

TREATMENT

treatment strategy and medications selected only by a doctor. During pregnancy, there are certain restrictions regarding the use of antibiotics, antiviral and some other drugs. All this you should definitely find out at the doctor's appointment. Naturally, best option- a planned pregnancy, before which you and your partner undergo all the necessary examinations and, if a disease is detected, carry out treatment.

Various antibiotics are used to treat pelvic inflammatory disease. After the end of treatment, a control smear from the vagina is taken from the woman to assess the effectiveness of therapy. During treatment, it is not recommended to live sexually. When continuing sexual intercourse, a man should use a condom. At the same time, the sexual partner (or sexual partners) of the woman is being treated, otherwise the risk of re-infection is high. In difficult cases, the patient is hospitalized. In the clinic, as a rule, they begin to administer antibiotics intravenously, then proceed to their oral administration. It happens (in about 15% of cases) that the initially prescribed antibiotic therapy does not help - then the antibiotic is changed. 20-25% of women of reproductive age have relapses of the disease, so a woman who has had such a disease should change her life in such a way as to minimize the risk of recurrent diseases.

print

WHO minimum criteria to establish the diagnosis of "inflammatory disease of the pelvic organs" are:

• pain on palpation of the lower abdomen
• pain in the uterine appendages,
• painful traction of the cervix.

To increase the specificity of diagnosis, there are additional criteria:

• body temperature above 38.3 ° C,
• pathological discharge from the cervix and vagina
• increase in ESR,
• increased levels of C-reactive protein,
• laboratory confirmation of cervical infection caused by gonococci, trichomonas, chlamydia.

Evidence criteria inflammatory diseases of the pelvic organs are:

• histopathological detection of endometritis on endometrial biopsy,
• ultrasound findings using transvaginal scanning demonstrating thickened, fluid-filled fallopian tubes with or without free fluid in the abdomen; the presence of tubo-ovarian formation,
• abnormalities detected during laparoscopy, corresponding to inflammatory diseases of the pelvic organs.

The most dangerous complication of inflammatory diseases of the pelvic organs is infertility. Its frequency is directly dependent on the duration and frequency of exacerbations of pelvic inflammatory diseases. The main complaints in this case are: infertility (primary or secondary), in 12% of cases - pain in the lower abdomen with an increase before menstruation, the presence of odorless liquid discharge, usually 4-5 days before it, 3-4 times a year with an interval of 3 -4 months, in 70% - psycho-emotional disorders (sleep disturbance, irritability, headache).

Other no less severe and significant complications of PID are ectopic pregnancy and adhesive bowel disease.

Currently, in order to diagnose urogenital infection, a number of methods are used that differ in sensitivity, specificity, ease of use, availability and price. The main and most common diagnostic method is PCR, which makes it possible to identify many infectious agents in body fluids and tissues, including chlamydia, urea-, mycoplasmas, gardnerella, cytomegaloviruses, herpes viruses 1 and 2, gonococci, Trichomonas, HIV, pathogens of tuberculosis and syphilis. In addition, immunofluorescent analysis is widely used, which determines monoclonal antibodies labeled with fluorescent. The sensitivity of this method is 98%, the specificity is 90%. It can also be used to diagnose chlamydia and mycoplasmosis.

Trichomonas vaginalis can be detected in a native preparation of contents from the vaginal vault, urethra, cervical canal, as well as when stained with an indicator - methylene blue. Gonococcus is detected in the discharge of the urethra, cervical canal, as well as the excretory ducts of the large vestibular glands when stained by Gram.

The culture method is the standard for detecting all types of infection, but its widespread use is limited by the duration, complexity and inconvenience of storing and transporting the material.

Abroad, in clinical practice, the so-called amplification diagnostic methods are most often used. In addition to PCR, this group includes: ligase chain reaction and ribosomal RNA amplification (TMA - transcription-mediated amplification). On the basis of amplification techniques, urinary tests have been developed that are quite convenient for use on an outpatient basis, but they have not yet become widespread in domestic practice.

It should be especially noted that the negative results of the study of material from the urethra, vaginal vaults and cervical canal cannot be considered reliable to exclude damage to the endometrium, myometrium and fallopian tubes. In this regard, the diagnostic significance of hystero- and laparoscopy should be emphasized, in which material can be taken from the uterus, fallopian tubes and peritoneal fluid. In addition, during an endoscopic examination, the condition of the uterus, endometrium and fallopian tubes is assessed. It is known that in patients with chlamydia in 71% of cases, the fallopian tubes are obstructed in the interstitial section, while in patients with "banal" inflammation in 53% of cases, the tubes are obstructed in the ampullar sections.

However, routine microbiological examination of material obtained even with laparoscopy is characterized by low sensitivity. When studying laparoscopic data in patients with visual signs of inflammation in 63% of cases, the microflora is not detected. It is localized in the thickness of inflamed tissues, which is confirmed by a study of the appendages and uterus removed according to indications using laparotomy.

Thus, it should be recognized that in reality the therapy of pelvic inflammatory diseases is predominantly empirical, and the results of incorrect microbiological studies are often misleading and may lead to castration rather than ensure the effectiveness of treatment.

=================
You are reading the topic:
Modern algorithm for the treatment of inflammatory diseases of the reproductive system.

Tikhomirov A.L., Yudaev V.N., Lubnin D.M. N. A. Semashko.
Published: "Medical Panorama" No. 9, November 2003.