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Pelvic inflammatory disease - Management
Basis for recommendation

Other investigations in secondary care

  • Transvaginal ultrasound is most useful in detecting large tubal swellings or fluid collections which only occur in women with severe pelvic inflammatory disease (PID) in whom irreversible tubal damage may already have occurred [Ross, 2003]. Power Doppler ultrasound is able to detect changes in blood flow associated with the hyperaemia that occurs with tubal inflammation [Ross, 2003].
  • The recommendation that transvaginal ultrasound scanning supported by power Doppler may be helpful is based on expert opinion in a guideline from the Royal College of Obstetricians and Gynaecologists who also commented that there is limited evidence that magnetic resonance imaging and computerized tomography can assist in making a diagnosis [RCOG, 2009].
  • Laparoscopy may provide information on the severity of the condition. However there is potential difficulty in identifying mild intra-tubal inflammation or endometritis and there is diagnostic variability between clinicians [Ross, 2003; BASHH, 2005a; RCOG, 2009].
  • Endometrial biopsy may be helpful, but there is insufficient evidence to support its routine use [Ross et al, 2008].

Surgical treatment

  • These recommendations are based on expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists and the British Association for Sexual Health and HIV [BASHH, 2005a; RCOG, 2009].
  • The British Association for Sexual Health and HIV [BASHH, 2005a] comment that although it is possible to perform adhesiolysis in women with peri-hepatitis there is no evidence that this is superior to antibiotic treatment alone.

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