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Pelvic inflammatory disease - Management
Basis for recommendation

Urgent admission

  • These recommendations are based on expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists [RCOG, 2009], the British Association for Sexual Health and HIV [BASHH, 2005a], the European guideline for the management of pelvic inflammatory disease [Ross et al, 2008], and guidelines from the Department of Health and Human Services Centres for Disease Control and Prevention [CDC, 2006].

Pregnant women

  • If the pregnancy is intrauterine, then pelvic inflammatory disease (PID) is rare except in the case of septic abortion [RCOG, 2009].
  • The recommendation that pregnant women with PID should be admitted to hospital under the care of an obstetrician is based on expert opinion, as intravenous antibiotics are required because of the increased risk of maternal and fetal morbidity and pre-term delivery [BASHH, 2005a; CDC, 2006; Ross et al, 2008; RCOG, 2009].
  • Neonatal complications can occur as a result of perinatal transmission of infection, such as ophthalmia neonatorum (due to Chlamydia trachomatis or Neisseria gonorrhoeae infection) and chlamydial pneumonitis [Brocklehurst and Rooney, 1998].

Women with HIV

  • Women with HIV may experience more severe symptoms of PID. 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] recommend that only women with severe disease should be admitted.

Suspected peri-hepatitis

  • Guidelines from the Royal College of Obstetricians and Gynaecologists and the British Association for Sexual Health and HIV [BASHH, 2005a; RCOG, 2009] state that although laparoscopic division of adhesions is sometimes performed, there is insufficient trial evidence to make any recommendations other than giving the usual treatment for PID. CKS therefore recommends seeking specialist advice if peri-hepatitis is suspected.

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