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Hamel C, Amir B, Avard B, Fung-Kee-Fung K, Furey B, Garel J, Ghandehari H. Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline. Can Assoc Radiol J 2024; 75:261-268. [PMID: 37624360 DOI: 10.1177/08465371231185292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Obstetrics and Gynecology Expert Panel consists of radiologists specializing in obstetrics and gynecology, obstetrics and gynecology physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 12 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 46 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 68 recommendation statements across the 12 scenarios related to the evaluation of obstetrics and gynecology clinical and diagnostic scenarios. This guideline presents the methods of development and the imaging recommendations for a variety of obstetrical and gynecological conditions including pregnancy assessment, recurrent first trimester pregnancy loss, post-partum indications, disorders of menstruation, localization of intra-uterine contraceptive device, infertility assessment, assessment of adnexal mass, pelvic pain of presumed gynecological origin, and pelvic floor evaluation.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | | | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | | | - Beth Furey
- Dalhousie University, Halifax, NS, Canada
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2
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Gaillard M, Meylaerts L, Govaerts K. Extrapelvic Endometriosis Mimicking Peritoneal Surface Malignancy: Case Report and a Review of Literature. Indian J Surg Oncol 2023; 14:131-143. [PMID: 37359914 PMCID: PMC10284773 DOI: 10.1007/s13193-022-01683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/06/2022] [Indexed: 12/04/2022] Open
Abstract
Extrapelvic endometriosis is a rare presentation of endometriosis with atypical clinical symptoms. It can mimic peritoneal surface malignancy, as well as some abdominal infectious diseases. A 29-year-old Moroccan woman presented with abdominal pain, progressive abdominal distention, and an intermittent inflammatory syndrome. Imaging revealed multiple, progressively growing abdominal cysts. She had elevated tumor markers CA125 and CA19.9. Despite thorough investigation, several differential diagnoses persisted for a long time. Definitive pathological diagnosis could only be established after debulking surgery. Literature review on malignant and benign conditions causing multicystic abdominal distention is provided. When definitive diagnosis is not established, but suspicion for peritoneal malignancy remains, a debulking procedure can be undertaken. Organ preservation can be pursued whenever benign disease is still considered. In case of malignancy, short-term (curative) debulking procedure with or without hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed.
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Affiliation(s)
- Marie Gaillard
- Department of Surgical Oncology, Ziekenhuis Oost Limburg, Genk, Belgium
| | | | - Kim Govaerts
- Department of Radiology, Ziekenhuis Oost Limburg, Genk, Belgium
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3
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El-Kharoubi AF. Tubal Pathologies and Fertility Outcomes: A Review. Cureus 2023; 15:e38881. [PMID: 37197301 PMCID: PMC10184952 DOI: 10.7759/cureus.38881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
Anomalies of the fallopian tubes represent one of the most significant elements that might contribute to reproductive issues. They can be inherited or acquired; they are among the most important problems of the profession. Although there is much discussion regarding which therapies for each tubal disease are the most effective and result in the best long-term reproductive outcomes. During the evaluation of an infertile couple, certain anomalies of the fallopian tubes are frequently discovered. These abnormalities were thought, for a long time, to not have an influence on fertility; however, in recent years, researchers have discovered that they seem to play a crucial role in fertility problems. Couples in industrialized countries are postponing childbearing, which raises the risk of women developing tubal diseases before they are ready to become pregnant. These disorders may have a negative impact on a woman's ability to get pregnant. The goals of this study are to conduct research to gain a deeper understanding of the recent advancements that have been made in the field of tubal diseases and to carry out an evaluation of the medical conducts that have the best fertility outcomes. We searched both Medline and PubMed, paying special attention to the most relevant articles that have been added to either database over the course of the last six years.
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Yu J, Zhou Y, Luo H, Su X, Gan T, Wang J, Ye Z, Deng Z, He J. Mycoplasma genitalium infection in the female reproductive system: Diseases and treatment. Front Microbiol 2023; 14:1098276. [PMID: 36896431 PMCID: PMC9989269 DOI: 10.3389/fmicb.2023.1098276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Mycoplasma genitalium is a newly emerged sexually transmitted disease pathogen and an independent risk factor for female cervicitis and pelvic inflammatory disease. The clinical symptoms caused by M. genitalium infection are mild and easily ignored. If left untreated, M. genitalium can grow along the reproductive tract and cause salpingitis, leading to infertility and ectopic pregnancy. Additionally, M. genitalium infection in late pregnancy can increase the incidence of preterm birth. M. genitalium infections are often accompanied by co-infection with other sexually transmitted pathogens (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis) and viral infections (Human Papilloma Virus and Human Immunodeficiency Virus). A recent study suggested that M. genitalium plays a role in tumor development in the female reproductive system. However, few studies endorsed this finding. In recent years, M. genitalium has evolved into a new "superbug" due to the emergence of macrolide-and fluoroquinolone-resistant strains leading to frequent therapy failures. This review summarizes the pathogenic characteristics of M. genitalium and the female reproductive diseases caused by M. genitalium (cervicitis, pelvic inflammatory disease, ectopic pregnancy, infertility, premature birth, co-infection, reproductive tumors, etc.), as well as its potential relationship with reproductive tumors and clinical treatment.
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Affiliation(s)
- Jianwei Yu
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yan Zhou
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Haodang Luo
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaoling Su
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Tian Gan
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Jingyun Wang
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Zufeng Ye
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Zhongliang Deng
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jun He
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China.,The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
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5
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Zografou Themeli M, Nirgianakis K, Neumann S, Imboden S, Mueller MD. Endometriosis is a risk factor for recurrent pelvic inflammatory disease after tubo-ovarian abscess surgery. Arch Gynecol Obstet 2023; 307:139-148. [PMID: 36036826 PMCID: PMC9422932 DOI: 10.1007/s00404-022-06743-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and prognosis of patients undergoing laparoscopic surgery for tubo-ovarian abscess (TOA) and identify risk factors for pelvic inflammatory disease (PID) recurrence. METHODS We conducted a retrospective cohort analysis including 98 women who underwent laparoscopic surgery for TOA at the Department of Obstetrics and Gynecology at the Bern University Hospital from January 2011 to May 2021. The primary outcome studied was the recurrence of PID after TOA surgery. Clinical, laboratory, imaging, and surgical outcomes were examined as possible risk factors for PID recurrence. RESULTS Out of the 98 patients included in the study, 21 (21.4%) presented at least one PID recurrence after surgery. In the univariate regression analysis, the presence of endometriosis, ovarian endometrioma, and the isolation of E. coli in the microbiology cultures correlated with PID recurrence. However, only endometriosis was identified as an independent risk factor in the multivariate analysis (OR (95% CI): 9.62 (1.931, 47.924), p < 0.01). With regard to the time of recurrence after surgery, two distinct recurrence clusters were observed. All patients with early recurrence (≤ 45 days after TOA surgery) were cured after 1 or 2 additional interventions, whereas 40% of the patients with late recurrence (> 45 days after TOA surgery) required 3 or more additional interventions until cured. CONCLUSION Endometriosis is a significant risk factor for PID recurrence after TOA surgery. Optimized therapeutic strategies such as closer postsurgical follow-up as well as longer antibiotic and hormonal therapy should be assessed in further studies in this specific patient population.
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Affiliation(s)
- Maria Zografou Themeli
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - Stephanie Neumann
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - M. D. Mueller
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
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Zhou T, Yuan M, Cui P, Li J, Jia F, Wang S, Liu R. Effectiveness and safety of morinidazole in the treatment of pelvic inflammatory disease: A multicenter, prospective, open-label phase IV trial. Front Med (Lausanne) 2022; 9:888186. [PMID: 35991648 PMCID: PMC9382104 DOI: 10.3389/fmed.2022.888186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAntimicrobial resistance to metronidazole has emerged after several decades of worldwide use of the drug. The purpose of this study was to evaluate the effectiveness, safety and population pharmacokinetics of morinidazole plus levofloxacin in adult women with pelvic inflammatory disease (PID).MethodsPatients in 30 hospitals received a 14-day course of 500 mg intravenous morinidazole twice daily plus 500 mg of levofloxacin daily. A total of 474 patients were included in the safety analysis set (SS); 398 patients were included in the full analysis set (FAS); 377 patients were included in the per protocol set (PPS); 16 patients were included in the microbiologically valid (MBV) population.ResultsThe clinical resolution rates in the FAS and PPS populations at the test of cure (TOC, primary effectiveness end point, 7–30 days post-therapy) visit were 81.91 and 82.49% (311/377), respectively. There were 332 patients who did not receive antibiotics before treatment, and the clinical cure rate was 82.83%. Among 66 patients who received antibiotics before treatment, 51 patients were clinically cured 7–30 days after treatment, with a clinical cure rate of 77.27%. The bacteriological success rate in the MBV population at the TOC visit was 87.5%. The minimum inhibitory concentration (MIC) values of morinidazole for use against these anaerobes ranged from 1 to 8 μg/mL. The rate of drug-related adverse events (AEs) was 27.43%, and no serious AEs or deaths occurred during the study.ConclusionsThe study showed that treatment with a 14-day course of intravenous morinidazole, 500 mg twice daily, plus levofloxacin 500 mg daily, was effective and safe. The results of this study were consistent with the results of a phase III clinical trial, which verified the effectiveness and safety of morinidazole.
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Affiliation(s)
- Ting Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Yuan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengfei Cui
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Li
- Department of Obstetrics and Gynecology, Liuzhou Worker's Hospital, Liuzhou, China
| | - Feifei Jia
- Department of Obstetrics and Gynecology, Panjin Central Hospital, Panjin, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ronghua Liu
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7
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Systematic Review and Meta-Analysis of Complications after Laparoscopic Surgery and Open Surgery in the Treatment of Pelvic Abscess. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3650213. [PMID: 35832848 PMCID: PMC9273437 DOI: 10.1155/2022/3650213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022]
Abstract
Background Pelvic abscess surgery consists mostly of open laparotomy and laparoscopic surgery. Open surgery is regarded as a classic procedure. With the rise and promotion of laparoscopic indications in recent years, comparative studies of the two's postoperative effectiveness have been limited. Objective To compare the clinical effects of laparoscopic exploratory surgery and open surgery in the treatment of pelvic abscess. Methods Through computer searches of PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases, we found publicly available case-control research on laparoscopic surgery and open surgery for treating pelvic abscess. The papers that met the evaluation criteria were screened, and meta-analysis was used to look at 8 papers on laparoscopic surgery and open surgery for treating pelvic abscess from 2010 to 2021. Results The results of this study showed that compared with the open laparotomy group, the incidence of laparoscopic group in the incision infection rate (RR = 0.29, 95% CI (0.20, 0.41), and P < 0.00001), the incidence of intestinal injury (RR = 0.08, 95% CI (0.04, 0.14), and P < 0.00001), incidence of intestinal obstruction (RR = 0.26, 95% CI (0.08, 0.90), and P = 0.03 < 0.05), and postoperative pelvic abscess recurrence rate (RR = 0.34, 95% CI (0.13, 0.86), and P = 0.02 < 0.05) are lower than open surgery, and the difference of these four items is statistically significant. There was no difference in the risk of urinary tract injury between laparoscopic surgery and open surgery (RR = 0.92, 95% CI (0.27, 3.17), and P = 0.89 > 0.05). Conclusion In terms of incision infection, intestinal damage, intestinal obstruction, and recurrence of pelvic abscess, the laparoscopic group clearly outperforms the open group, and it merits clinical promotion and use.
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8
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Goje O, Markwei M, Kollikonda S, Chavan M, Soper DE. Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review. J Minim Invasive Gynecol 2021; 28:556-564. [PMID: 32992023 DOI: 10.1016/j.jmig.2020.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/09/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the success rate, complications, and hospital length-of-stay of 3 modalities of minimally invasive management of tubo-ovarian abscesses (TOAs): laparoscopy, ultrasound-guided drainage, and computed tomography-guided drainage. DATA SOURCES Electronic-based search in PubMed, EMBASE, Ovid MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, using the following Medical Subject Heading terms: "minimally invasive surgical procedures," "drainage," "abscess," "tubo-ovarian," "ovarian diseases," and "fallopian tube diseases." METHODS OF STUDY SELECTION Of the 831 articles in the initial results, 10 studies were eligible for inclusion in our systematic review. TABULATION, INTEGRATION, AND RESULTS A total of 975 patients were included in our study; 107 (11%) had laparoscopic drainage procedures, and 406 (42%) had image-guided (ultrasound or computed tomography) drainage of TOAs. Image-guided TOA drainage had higher success rates (90%-100%) than laparoscopic drainage (89%-96%) and the use of antibiotic treatment alone (65%-83%). Patients treated with image-guided drainage had no complications (for up to 6 months of follow-up) and shorter lengths of hospital stay (0-3 days on average) compared with laparoscopic drainage (5-12 days) or conservative management with antibiotics alone (7-9 days). CONCLUSION Although conservative management of TOAs with antibiotics alone remains first-line, our review indicates that better outcomes in the management of TOA were achieved by minimally invasive approach compared with conservative treatment with antibiotics only. Of the minimally invasive techniques, image-guided drainage of TOAs provided the highest success rates, the fewest complications, and the shortest hospital stays compared with laparoscopy. The low magnitude of evidence in the included studies calls for further randomized trials. This systematic review was registered in the International Prospective Register of Systematic Review (register, http://www.crd.york.ac.uk/PROSPERO;CRD 42020170345).
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Affiliation(s)
- Oluwatosin Goje
- Obstetrics & Gynecology and Women's Health Institute, Cleveland Clinic Foundation (Drs. Goje and Kollikonda).
| | - Metabel Markwei
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (Ms. Markwei)
| | - Swapna Kollikonda
- Obstetrics & Gynecology and Women's Health Institute, Cleveland Clinic Foundation (Drs. Goje and Kollikonda)
| | - Monica Chavan
- Case Western Reserve University School of Medicine (Ms. Chavan), Cleveland, Ohio
| | - David E Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina (Dr. Soper)
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9
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Gao Y, Qu P, Zhou Y, Ding W. Risk factors for the development of tubo-ovarian abscesses in women with ovarian endometriosis: a retrospective matched case-control study. BMC WOMENS HEALTH 2021; 21:43. [PMID: 33516203 PMCID: PMC7847172 DOI: 10.1186/s12905-021-01188-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to assess the risk factors associated with the development of tubo-ovarian abscesses in women with ovarian endometriosis cysts. METHODS This retrospective single-center study included 176 women: 44 with tubo-ovarian abscesses associated with ovarian endometriosis and 132 age-matched (1:3) patients with ovarian endometriosis but without tubo-ovarian abscesses. Diagnoses were made via surgical exploration and pathological examination. The potential risk factors of tubo-ovarian abscesses associated with ovarian endometriosis were evaluated using univariate analysis. The results (p ≤ 0.05) of these parameters were analyzed using a multivariate model. RESULTS Five factors were included in the multivariate conditional logistic regression model, including in vitro fertilization, presence of an intrauterine device, lower genital tract infection, spontaneous rupture of ovarian endometriosis cysts, and diabetes mellitus. The presence of a lower genital tract infection (odds ratio 5.462, 95% CI 1.772-16.839) and spontaneous rupture of ovarian endometriosis cysts (odds ratio 2.572, 95% CI 1.071-6.174) were found to be statistically significant risk factors for tubo-ovarian abscesses associated with ovarian endometriosis. CONCLUSIONS Among the factors investigated, genital tract infections and spontaneous rupture of ovarian endometriosis cysts were found to be involved in the occurrence of tubo-ovarian abscesses associated with ovarian endometriosis. Our findings indicate that tubo-ovarian abscesses associated with ovarian endometriosis may not be linked to in vitro fertilization as previously thought.
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Affiliation(s)
- Yang Gao
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, 300100, Tianjin, China.,Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, 300100, Tianjin, China. .,Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, China.
| | - Yang Zhou
- Department of Intensive Care, People's Hospital of Tianjin Affiliated to Nankai University, Tianjin, China
| | - Wei Ding
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, 300100, Tianjin, China
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Castan B, Brun JL, Stahl JP, Martin C, Mercier F, Fritel X, Agostini A. [Prevention of postoperative or associated of care pelvic inflammatory diseases. Is there a need for antibiotic prophylaxis for first trimester surgical-induced abortion to prevent pelvic inflammatory diseases? CNGOF good practice points]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:646-648. [PMID: 32590078 DOI: 10.1016/j.gofs.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Antibiotic prophylaxis is not recommended during surgical induced abortions. Systematic screening for Chlamydia trachomatis and Neisseria gonorrheae infection by polymerase chain reaction (PCR) on a vaginal sample is recommended before any surgical abortion. Moreover, the bacteriological result should be available before the abortion so that antibiotic treatment effective against the identified bacteria, if any, can be proposed before the procedure. The absence of bacteriological result on the day of the abortion must not, however, delay the procedure. If screening is positive for a sexually transmitted infection (STI), and the bacteriological result is only available after the abortion, it is recommended that antibiotic treatment start as soon as possible. The first-line antibiotic treatment is ceftriaxone 500mg in a single dose by the intramuscular route for N. gonorrheae, doxycycline 200mg per day orally for 7 days for C. trachomatis and azithromycin 500mg the first day (D1) then 250mg per day from D2 to D4 orally if Mycoplasma genitalium is detected by multiplex PCR. In case of positive screening, antibiotic treatment of the woman's partner(s) is recommended, adapted to the STI agent(s).
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Affiliation(s)
- B Castan
- Service des maladies infectieuses et tropicales, centre hospitalier de Périgueux, 24000 Périgueux, France
| | - J-L Brun
- Service de chirurgie gynécologique, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France.
| | - J-P Stahl
- Service des maladies infectieuses et tropicales, hôpital Michallon, CHU de Grenoble, 38043 Grenoble, France
| | - C Martin
- Service d'anesthésie-réanimation, hôpital Nord, AP-HM, 13020 Marseille, France
| | - F Mercier
- Service d'anesthésie-réanimation, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - X Fritel
- Service de gynécologie obstétrique, hôpital de la Milétrie, CHU de Poitiers, 86000 Poitiers, France
| | - A Agostini
- Service de gynécologie obstétrique, hôpital de la Conception, AP-HM, 13005 Marseille, France
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11
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Pelvic inflammatory diseases: Updated French guidelines. J Gynecol Obstet Hum Reprod 2020; 49:101714. [PMID: 32087306 DOI: 10.1016/j.jogoh.2020.101714] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/03/2020] [Indexed: 11/22/2022]
Abstract
Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to rule out tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1 g, once, IM or IV, doxycycline 100 mg ×2/day, and metronidazole 500 mg ×2/day PO for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1-2 g/day until clinical improvement, doxycycline 100 mg ×2/day, IV or PO, and metronidazole 500 mg ×3/day, IV or PO for 14 days (grade B). Drainage of TOA is indicated if the pelvic fluid collection measures more than 3 cm (grade B). Follow-up is required in women with sexually transmitted infections (STIs) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3-6 months after PID (grade C), before the insertion of an intrauterine device (grade B), and before elective termination of pregnancy or hysterosalpingography. When specific bacteria are identified, antibiotics targeted at them are preferable to systematic antibiotic prophylaxis.
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12
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Jiang X, Shi M, Sui M, Wang T, Yang H, Zhou H, Zhao K. Clinical value of early laparoscopic therapy in the management of tubo-ovarian or pelvic abscess. Exp Ther Med 2019; 18:1115-1122. [PMID: 31384333 PMCID: PMC6639770 DOI: 10.3892/etm.2019.7699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/17/2019] [Indexed: 11/24/2022] Open
Abstract
Broad-spectrum antibiotics are the conservative treatment for tubo-ovarian abscess (TOA) or pelvic abscess, but the failure rate of antibiotic therapy remains higher in patients with a larger abscess. The present study aimed to evaluate the clinical value of early laparoscopic therapy in the management of TOA or pelvic abscess. A total of 100 patients were enrolled and their medical records were retrospectively analyzed after excluding 6 patients with malignant diseases. Based on the treatment they had received, the patients were divided into a conservative treatment group (n=41) and an early laparoscopic treatment group (n=53). In the conservative treatment group, 21 patients (51.2%) finally received laparoscopic exploration (late laparoscopic treatment group), and 20 patients (48.8%) achieved a success of antibiotic therapy (successful antibiotic therapy group). The cut-off value of abscess size for predicting antibiotic treatment failure was determined using receiver operating characteristic curve analysis. Multivariate logistic regression analyses were used to explore the association between the clinical variables and antibiotic therapy failure in conservative treatment group. The durations of elevated temperature >38.0°C and hospitalization were significantly longer in the conservative treatment group than those in the early laparoscopic treatment group (all P<0.001). The patients in the late laparoscopic treatment group had a larger abscess size than those in the successful antibiotic therapy group (6.2±1.8 cm vs. 4.8±1.4 cm, P=0.008). An abscess diameter of 5.5 cm was obtained as the cut-off of antibiotic failure, and the sensitivity and specificity were 81.0 and 85.0%, respectively. An abscess diameter of ≥5.5 cm was independently associated with antibiotic failure (odds ratio=5.724; 95%CI: 2.025–16.182; P=0.001). In conclusion, early laparoscopic treatment was associated with a better clinical prognosis than conservative treatment and late laparoscopic therapy for TOA or pelvic abscess patients.
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Affiliation(s)
- Xiaofei Jiang
- Department of Gynecology, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China
| | - Mingqing Shi
- Department of Obstetrics and Gynecology, Lishui Hospital of Chinese Medicine, Lishui, Zhejiang 323000, P.R. China
| | - Miao Sui
- Department of Endocrinology, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China
| | - Tao Wang
- Department of Gynecology, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China
| | - Haiyan Yang
- Department of Science and Education, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China
| | - Huifang Zhou
- Department of Gynecology, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China.,The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, P.R. China
| | - Kai Zhao
- Department of Gynecology, Xuzhou City Hospital of Chinese Medicine, Xuzhou, Jiangsu 221003, P.R. China
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13
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Gremeau AS, Girard A, Lambert C, Chauvet P, Bourdel N, Canis M, Pouly JL. Benefits of second-look laparoscopy in the management of pelvic inflammatory disease. J Gynecol Obstet Hum Reprod 2019; 48:413-417. [PMID: 30910760 DOI: 10.1016/j.jogoh.2019.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the benefits of second-look laparoscopy (SLL) in pelvic inflammatory disease (PID). STUDY DESIGN A 5- year retrospective study conducted at Clermont-Ferrand University Hospital and included all patients who had undergone SLL following a PID. Data collection comprised patient and disease characteristics, type of initial medical or surgical treatment, adhesion (AFS) and tubal (MAGE) scores recorded during SLL and outcomes following subsequent pregnancies. RESULTS 76 patients who had received SLL were included. A higher rate of severe adhesions was recorded during SLL in patients with stage 3 PID, than for women with stage 1 and 2 (63.6% versus 25%, p = 0.01). A higher rate of Mage scores of 4 were also found in patients with stage 3 PID (25.8% versus 0%, p = 0.001). Multivariate analysis revealed that women at stage 3 are 17 times more likely to have a high level of adhesions than patients at stage 1 (OR [95% CI] = 17.4 [1.7; 1]). A Mage score of 1was found to be associated with higher pregnancy and live birth rates. CONCLUSION(S) SLL seems presents benefits for the preservation of fertility in cases of severe PID with tubo ovarian abcess and may be proposed to patients with stage 3 salpingitis and desire for pregnancy. Further prospective randomized study should be done to confirm these results.
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Affiliation(s)
| | - Anais Girard
- Department of Gynecology, University Hospital, Clermont-Ferrand, France
| | - Celine Lambert
- Biostatistics Unit (DRCI), University Hospital, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynecology, University Hospital, Clermont-Ferrand, France
| | - Nicolas Bourdel
- Department of Gynecology, University Hospital, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynecology, University Hospital, Clermont-Ferrand, France
| | - Jean Luc Pouly
- Department of Gynecology, University Hospital, Clermont-Ferrand, France
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Graesslin O, Verdon R, Raimond E, Koskas M, Garbin O. [Management of tubo-ovarian abscesses and complicated pelvic inflammatory disease: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:431-441. [PMID: 30880246 DOI: 10.1016/j.gofs.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Indexed: 01/09/2023]
Abstract
A tubo-ovarian abscess (ATO) should be suspected in a context of pelvic inflammatory disease (PID) in case of severe pain associated with the presence of general signs and palpation of an adnexal mass at pelvic examination. Imaging allows most often a rapid diagnosis, by ultrasound or CT, the latter being irradiant but also allowing to consider the differential diagnoses (digestive or urinary diseases) in case of pelvic pain. MRI, non-irradiating examination, whenever it is feasible, provides relevant information, more efficient, guiding quickly the diagnosis. The diagnosis of tubo-ovarian abscess should lead to the hospitalization of the patient, the collection of bacteriological samples, the initiation of a probabilistic antibiotherapy associated with drainage of the purulent collection. In severe septic forms (generalized peritonitis, septic shock), surgery (laparoscopy or laparotomy) keeps its place. In other situations, ultrasound-guided trans-vaginal puncture in the absence of major hemostasis disorders or severe sepsis is a less morbid alternative to surgery and provides high rates of cure. Today, ultrasound-guided trans-vaginal puncture has been satisfactory evaluated in the literature and is part of a logic of therapeutic de-escalation. Randomized trials evaluating laparoscopic drainage versus radiological drainage should be able to answer, in the coming years, questions that are still outstanding (impact on chronic pelvic pain, fertility). The recommendations for the management of ATO published in 2012 by the CNGOF remain valid, legitimizing the place of radiological drainage associated with antibiotic therapy.
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Affiliation(s)
- O Graesslin
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - R Verdon
- Service de maladies infectieuses et tropicales, CHRU de Caen, 14000 Caen, France
| | - E Raimond
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris, France
| | - O Garbin
- Service de gynécologie, CMCO, pôle de gynécologie des hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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15
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Verdon R. [Treatment of uncomplicated pelvic inflammatory disease: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:418-430. [PMID: 30878689 DOI: 10.1016/j.gofs.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Indexed: 11/25/2022]
Abstract
This review of the treatment of uncomplicated pelvic inflammatory disease (PID) focuses on the susceptibility profile of the main microbiological causes as well as on the advantages and inconvenients of relevant antibiotics. As bacterial resistance is expanding in the community, the rules of adequate antibiotic prescribing are integrated in the treatment proposals. While the pathogenic role of anaerobic bacteria in uncomplicated PID remains discussed, the choice to provide anaerobes coverage is proposed. Thus, the antibiotic treatment has to cover Chamydia trachomatis, Neisseria gonorrhoeae, anaerobes as well as Streptococcus spp, gram negative bacteria and the ermerging Mycoplasma genitalium. On the basis of published trials and good practice antibiotic usage, the ceftriaxone-doxycycline-metronidazole combination has been selected as the first line regimen. Fluoroquinolones (moxifloxacin alone, or levofloxacin or ofloxacin combined with metronidazole) are proposed as alternatives because of their ecological impact and their side effects leading to restricted usage. When fluoroquinolone are used, ceftriaxone should be added in case of possible sexually transmitted infection. When detected, M. genitalium should be treated by moxifloxacin. Moreover, this review highlights the need to better describe the microbiological epidemiology of uncomplicated PID in France or Europe.
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Affiliation(s)
- R Verdon
- Service de maladies infectieuses et tropicales, CHRU de Caen, 14000 Caen, France; Groupe de recherche sur l'adaptation microbienne (GRAM 2.0), Normandie university, UNICAEN, 14000 Caen, France.
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16
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Castan B. [Prevention of postoperative or associated of care pelvic inflammatory diseases: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:451-457. [PMID: 30858077 DOI: 10.1016/j.gofs.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 10/27/2022]
Abstract
Numerous prophylactic antibiotic regimens (PBR) have been evaluated particularly in surgical abortion, hysterosalpingography or caesarean section, but few randomized comparative trials are available. Recommendations for PBR should take into account, expected and demonstrated benefits that reduce the risk of surgical site infection, but also the impact on the microbiota, the risk of bacterial resistance selection, and the overall cost to the community. In addition, antibiotic prophylaxis is not the only one factor to reduce the risk of surgical site infection, such as preventive measures and good hygiene practices.
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Affiliation(s)
- B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, hôpital Eugénie, boulevard Rossini, 20000 Ajaccio, France; Coordinateur du groupe des recommandations de la Société de pathologie infectieuse de langue française (SPILF), 21, rue Beaurepaire, 75010 Paris, France.
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17
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Straub T, Reynaud M, Yaron M. [Intrauterine device and pelvic inflammatory disease: Myth or reality?]. ACTA ACUST UNITED AC 2018; 46:414-418. [PMID: 29627410 DOI: 10.1016/j.gofs.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intrauterine device (IUD) is a reliable contraceptive method that is long term reversible, and well tolerated. Numerous studies prove its efficiency and report rare complications that are attributed to it. However, its use is limited due to fear that it can cause a pelvic inflammatory disease (PID). This is based on historical data on infections related to the "Dalkon Shield", which was removed from the market in 1974. METHOD The analyzed articles were extracted from PUBMED database between 2000 and 2016. In total, 22 studies were retained. A meta-analysis was not possible due to the methodological diversity among the selected articles contributing to this narrative review of the literature. RESULTS After analysis, the following factors influence the risk of PID linked to IUDs: an advanced age and sexually transmitted infections. CONCLUSION The risk of PID linked to IUDs is lower than 1%. This is explained by new models of IUD, better screening tests, more frequent follow-up of the patients and the improvement of care PID patients. In the light of our results, the threat of pelvic inflammatory disease should not hinder the use of IUDs.
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Affiliation(s)
- T Straub
- Hôpital cantonal de Fribourg, HFR, Fribourg 1700, Suisse
| | - M Reynaud
- Hôpital des Trois-Chênes (HUG), Genève, Suisse
| | - M Yaron
- Maternité des hôpitaux universitaires de Genève (HUG), boulevard de la Cluse 30, 1205 Genève, Suisse.
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Vayssière C, Gaudineau A, Attali L, Bettahar K, Eyraud S, Faucher P, Fournet P, Hassoun D, Hatchuel M, Jamin C, Letombe B, Linet T, Msika Razon M, Ohanessian A, Segain H, Vigoureux S, Winer N, Wylomanski S, Agostini A. Elective abortion: Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2018; 222:95-101. [PMID: 29408754 DOI: 10.1016/j.ejogrb.2018.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
The number of elective abortions has been stable for several decades. Many factors explain women's choice of abortion in cases of unplanned pregnancies. Early initiation of contraceptive use and a choice of contraceptive choices appropriate to the woman's life are associated with lower rates of unplanned pregnancies. Reversible long-acting contraceptives should be favored as first-line methods for adolescents because of their effectiveness (grade C). Ultrasound scan before an elective abortion must be encouraged but should not be obligatory (professional consensus). As soon as the embryo appears on the ultrasound scan, the date of pregnancy is estimated by measuring the crown-rump length (CRL) or, from 11 weeks on, by measuring the biparietal diameter (BPD) (grade A). Because reliability of these parameters is ±5 days, the abortion may be done if measurements are respectively less than 90 mm for CRL and less than 30 mm for BPD (professional consensus). A medically induced abortion, performed with a dose of 200 mg mifepristone combined with misoprostol, is effective at any gestational age (Level of Evidence (LE) 1). Before 7 weeks, mifepristone should be followed 24-48 h later by misoprostol, administered orally, buccally, sublingually, or even vaginally followed if needed by a further dose of 400 μg after 3 h, to be renewed if needed after 3 h (LE 1, grade A). After 7 weeks, administration of misoprostol by the vaginal, sublingual, or buccal routes is more effective and better tolerated than by the oral route (LE 1). Cervical preparation is recommended for systematic use in surgical abortions (professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 μg (grade A). Vacuum aspiration is preferable to curettage (grade B). A uterus perforated during surgical aspiration should not routinely be considered to be scarred (professional consensus). An elective abortion is not associated with a higher risk of subsequent infertility or ectopic pregnancy (LE 2). The medical consultation before an elective abortion generally does not affect the decision to end or continue the pregnancy, and most women are sufficiently certain about their choice at this time. Women appear to find the method used most acceptable and to be most satisfied when they were able to choose the method (grade B). Elective abortions are not associated with an increased rate of psychiatric disorders (LE 2). However, women with psychiatric histories are at a higher risk of psychological disorders after the occurrence of an unplanned pregnancy than women with such a history (LE 2). For surgical abortions, combined hormonal contraceptives - oral or transdermal - should be started on the day of the abortion, while the vaginal ring should be inserted 5 days afterwards (grade B). For medical abortions, the vaginal ring should be inserted in the week after mifepristone administration, while the combined contraceptives should begin the same day as the misoprostol or the day after (grade C). Contraceptive implants should be inserted on the same day as a surgical abortion, and may be inserted the day the mifepristone is administered for medical abortions (grade B and C respectively). In case of medical abortion, the implant can be inserted the same day the mifepristone is administered (grade C). Both the copper IUDs and levonorgestrel intrauterine system should be inserted on the day of the surgical abortion (grade A). After medical abortions, an IUD can be inserted in 10 days after mifepristone administration, after ultrasound scan verification of the absence of an intrauterine pregnancy (grade C).
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Affiliation(s)
- Christophe Vayssière
- Pôle Femme-Mère-Couple, service de gynecologie-obstétrique, Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France; UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France.
| | - Adrien Gaudineau
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Luisa Attali
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Karima Bettahar
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Sophie Eyraud
- 3 rue Pierre d'Artagnan, 92350 Le Plessis-Robinson, France
| | - Philippe Faucher
- Unité fonctionnelle d'orthogénie, Hôpital Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Patrick Fournet
- Service de Gynécologie Obstétrique, Centre Hospitalier du Belvedere 72, rue Louis Pasteur, 76451 Mont Saint Aignan, France
| | | | | | | | - Brigitte Letombe
- Service de Gynécologoe-Obstétrique, Hôpital Jeanne de Flandre, CHRU Lille, 2 av Oscar Lambret, 59000 Lille, France
| | - Teddy Linet
- Service de Gynécologie Obstétrique, Centre Hospitalier Loire Vendée Océan, Bd Guerin, 85300, Challans, France
| | - Marie Msika Razon
- MFPF, Mouvement français pour le planning familial, Tour Manto, Bd Massena, 75013 Paris, France
| | - Alexandra Ohanessian
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
| | - Hélène Segain
- Service de Gynécologie-Obstétrique, CHI de Poissy-St-Germain, 45 rue du Champs Gaillard, 78303 Poissy, France
| | - Solène Vigoureux
- Service de gynécologie-obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), U1018, Equipe « Genre, Sexualité et Santé », 94276 Le Kremlin-Bicêtre, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Sophie Wylomanski
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Aubert Agostini
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
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Efficacy and safety of morinidazole in pelvic inflammatory disease: results of a multicenter, double-blind, randomized trial. Eur J Clin Microbiol Infect Dis 2017; 36:1225-1230. [DOI: 10.1007/s10096-017-2913-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
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20
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Bettahar K, Pinton A, Boisramé T, Cavillon V, Wylomanski S, Nisand I, Hassoun D. Interruption volontaire de grossesse par voie médicamenteuse. ACTA ACUST UNITED AC 2016; 45:1490-1514. [DOI: 10.1016/j.jgyn.2016.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
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