Файловый архив студентов. Файловый архив студентов.
1327 вузов, 5482 предметов.
/ Регистрация
FAQ Обратная связь Вопросы и предложения
Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Ростовский Государственный Медицинский Университет
Предмет:
Медицина общая
Файл:

Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 220 - файл

.pdf
Скачиваний:
0
Добавлен:
28.08.2026
Размер:
86 Мб
Скачать
☆
350
https://t.me/medicina_free
13 Complicated Pelvic Inammatory Disease
a
Fig. 13.9 (a) Laparoscopic image of a left ovarian mass consistent with abscess and disseminated purulent uid. (b) Appearance after excision of the mass and irrigation of the pelvis. (Reproduced with permission from [73] under the CC BY 2.5)
13.10.4 Obstetric Management
CS is the most common mode of delivery [54]. With late decelerations, fetal bradycardia, or an increase in uterine contractions of a viable fetus, CS is performed during operative treatment of ruptured PID [60]. In near-term pregnancy, induction of labor is recommended. When the fetus is removed from the source of infection, any antibiotic can be administered to the mother. Also, if conservative therapy fails, laparoscopy is technically easier with the smaller uterus in the postpartum period [156].
13.11 Prognosis
13.11.1 Maternal Outcome
13.11.1.1 Tubo-Ovarian Abscess
At the beginning of the twentieth century, mater­nal survival was excellent, with more cases of pelvic tuberculosis during pregnancy [157]. With completely changed underlying microbial ora causing complicated PID in pregnancy, the maternal outcome is still excellent, with survival approaching 100% [73, 158]. Delay in diagnosis and treatment, especially with ruptured TOA causing peritonitis, increases the possibility of maternal mortality and morbidity [56]. Fertility impairment following TOA results from postin­ammatory tubal obstruction [159].
b
Compared to non-PID patients, PID patients have approximately 2× higher risk of preterm labor and ectopic pregnancy [160].
Due to a small number of patients and vari­ous PID stages, firm conclusions cannot be made. Surgical and percutaneous intervention carries 50% of the spontaneous abortion rate in first- trimester pregnancies. The TOA caused by TVOR seems to be better maintained dur­ing pregnancy, and the perinatal outcome is better than the naturally occurring TOA [67]. Surgical and percutaneous intervention could have a similar 50% abortion rate during the first trimester. During 14–20 weeks of preg­nancy, the cases are exceptionally rare, and conclusions cannot be made. After 20weeks of gestation, surgical treatment has a high delivery rate but cannot be compared to other methods performed in 1–3 patients [67]. Spontaneous TOA and TOA after TVOR have similar ratios (3:1) of delivery and abortion after 20 weeks of gestation. Through all tri­mesters, TOA without therapy has a 100% abortion rate [67].
13.11.1.2 Ovarian Abscess
Tenani, in 1921, reported the rupture of a pyo­ovarium during the second stage of labor, fol­lowed by maternal streptococci peritonitis and death [49]. Currently, maternal survival is 100% [27, 72]. Pelvic actinomycosis has low virulence, which is probably why spontaneous abortion
References
https://t.me/medicina_free
351
does not occur. The preterm labor rate could be increased, but the number of cases is too small for denitive conclusions [27, 28].
13.11.1.3 Surgical Complications
Surgical complications inuence further preg­nancy and delivery, including surgical site infections, increased intra-abdominal pressure, and burst abdomen (see Chap. 22) [152].
13.11.2 Fetal Outcome
Fetal and neonatal mortality combined is 10.3– 50% [54, 161, 162]. The majority of births are at term [54]. Term delivery results from surgical [133, 163] or antibiotic [164] treatment during pregnancy. Live births have a high incidence of associated morbidities, such as neurological sequelae [161, 162]. Neonates can develop early­or late-onset sepsis and often have no apparent perinatal risk factor [162]. Reasons for the increase of pneumococcal neonatal sepsis recently may be the following: (1) increased rates of genital S. pneumoniae colonization due to changes in sexual practice (i.e., increased oro­genital sex); (2) improved laboratory isolation techniques; (3) the increased use of antimicrobi­als for prevention of group B streptococcal dis­ease selecting for more resistant pathogens such as S. pneumoniae [165]; and (4) publication bias with positive cases being published more fre­quently [161]. Possibly the type of bacteria dic­tates the rate of fetal loss (spontaneous abortion). The most common is type II atrial septal defect (Or 4.2) [166].
Acute PID in pregnancy results in an increased
rate of congenital cardiovascular anomalies (OR
2.6). Up to 1971, gonorrheal salpingitis/TOA had
50% fetal loss [126].
Fruhinsholz and Feuillade, in 1924, in their
classical paper dealing with utero-adnexal tuber­culosis and pregnancy, referred to cases reported by various observers of normal pregnancy fol­lowing conservative surgery for pelvic tuberculo­sis [157]. Today, pelvic tuberculosis in pregnancy is extremely rare.
13.11.2.1 Acute Salpingitis
Previously, the fetal outcome was poor. Up to 1993, the average gestational age at diagnosis was 12 weeks; 27% of patients reached term pregnancy and delivered; 40% resulted in sponta­neous abortions, 13% in stillbirth, and 7% in pre­mature delivery with fetal death [167].
13.11.2.2 Tubo-Ovarian Abscess
Several possible explanations for the role of infection in reducing pregnancy success have been suggested, especially during IVF-ET preg­nancy with PID. Introducing endotoxin-releas­ing bacteria into the peritoneal cavity during TVOR may induce abortion by promoting the release of prostaglandins, catecholamines, and cortisol, which play a role in the termination of pregnancy. Moreover, local inammatory reac­tions and fever may also affect pregnancy suc­cess rates [168].
Overall fetal loss was 36.8%, and surgically treated patients included 92.9% of overall fetal loss [60]. Pregnancy loss occurred in 90%, with TOA developing before 24 weeks of gestation [105]. The fetal survival rate of those pregnancies complicated by a TOA late in the second trimes­ter was 33% [106, 169]. The fetal mortality rate after PID from IVF-ET depends on the gesta­tional age and reaches 40–50% overall [107,
138]. A full-term pregnancy is reached in 1/3 of
cases [107].
13.11.2.3 Ovarian Abscess
Fetal mortality from OA depends on many fac­tors. Different authors claim different survival. Some claim extremely low fetal survival, with live cases delivered prematurely with severe fetal complications [56, 73, 87]. Others claim excel­lent survival of healthy newborns [27, 72].
References
1. Walker CK, Landers DV. Pelvic abscesses: new trends in the management of tuboovarian abscesses. Obstet Gynecol Surv. 1991;46:615–24.
2. Landers DV, Sweet RL.Tubo-ovarian abscess: con­temporary approach to management. Rev Infect Dis. 1983;5:876–84.
352
https://t.me/medicina_free
13 Complicated Pelvic Inammatory Disease
3. Rekart M, Meza R, etal. Chlamydia public health programs and the epidemiology of pelvic inam­matory disease and ectopic pregnancy. J Infect Dis. 2013;207:30–8.
4. Krivak A, Propst A, Horowitz GTP. Tubo-ovarian abscess. Principles of contemporary management. Fem Patient. 1997;22:27–44.
5. Soper D. Pelvic inammatory disease. Infect Dis Clin N Am. 1994;8:821–40.
6. Roberts W, Dockery JL. Operative and conserva­tive treatment of tubo-ovarian abscess due to pelvic inammatory disease. South Med J. 1984;77:860–3.
7. Landers D.Tubo-ovarian abscess complicating pel­vic inammatory disease. In: Landers DV, Sweet R, editors. Pelvic inammatory disease. NewYork: Springer; 1996. p.94.
8. Brun JL, Castan B, de Barbeyrac B, Cazanave C, Charvériat A, Faure K, et al. Pelvic inammatory diseases: updated French guidelines. J Gynecol Obstet Hum Reprod. 2020;49(5):101714.
9. Ribak R, Schonman R, Sharvit M, Schreiber H, Raviv O, Klein Z.Can the need for invasive inter­vention in tubo-ovarian abscess be predicted? The implication of C-reactive protein measurements. J Minim Invasive Gynecol. 2020;27(2):541–7.
10. Brun JL, Graesslin O, Fauconnier A, Verdon R, Agostini A, Bourret A, et al. Updated French guidelines for diagnosis and management of pel­vic inammatory disease. Int J Gynecol Obstet. 2016;134(2):121–5.
11. Lackner JE, Tulsky AS. Abortion as a complica­tion of operation in the pregnant woman. A plea for the prophylactic use of progesterone. Am J Surg. 1939;46:362–4.
12. Kaplan WM, Ehresman JBAJ.Aggressive manage­ment of pelvic abscesses. Am J Obstet Gynecol. 1967;98:482–7.
13. Hunt BW, Schreier PCSK.Tubo-ovarian abscess in pregnancy. Obstet Gynecol. 1974;43:57–60.
14. Laohaburanakit P, Tantawichian T, Bunyavejchevin S, etal. Ruptured tuboovarian abscess in late preg­nancy. A case report. J Reprod Med. 1999;44:551–5.
15. Brun O, Fauconnier A, et al. Updated French guidelines for diagnosis and management of pel­vic inammatory disease. Int J Gynaecol Obstet. 2016;134:121–5.
16. Rivlin M. Clinical outcome following vagi­nal drainage of pelvic abscess. Obstet Gynecol. 1983;61:169–73.
17. Rubenstein DR, Ledger WIPM.Colpotomy drainage of pelvic abscess. Obstet Gynecol. 1976;48:142–5.
18. Mann TGWS, editor. Gynecologic surgery. NewYork: Churchill Livingstone; 1996. p.668.
19. Reich FHM. Laparoscopic treatment of tubo­ovarian and pelvic abscesses. J Reprod Med. 1987;32:747–52.
20. Rivlin JAMH. Ruptured tubo-ovarian abscess: is hysterectomy necessary? Obstet Gynecol. 1977;50:518–22.
21. Ginsberg JL, Hamod KA, et al. Tubo-ovarian abscess, a retrospective review. Am J Obstet Gynecol. 1980;138:1055–8.
22. Zhu S, Ballard E, Khalil A, Baartz D, Amoako A, Tanaka K. Impact of early surgical management on tubo-ovarian abscesses. J Obstet Gynaecol. 2021;41(7):1097–101.
23. Wong TTC, Lau HCQ, Tan TC.Retrospective study on the efcacy and prognostic factors of conserva­tive versus drainage of tubo-ovarian abscesses. Arch Gynecol Obstet. 2020;302(3):679–83.
24. Black W.Abscess of ovary. Am J Obstet Gynecol. 1936;31:487–94.
25. Wetchler LJSD. Ovarian abscess. Report of a case and a review of the literature. Obstet Gynecol Surv. 1985;40:476–85.
26. Stubbleeld P.Intraovarian abscess treated with lap­aroscopic aspiration and povidone–iodine lavage. J Reprod Med. 1991;36:407–9.
27. de Clercq J, Thiery M, etal. Ovarian actinomyco­sis during rst trimester pregnancy. Adv Contracept. 1987;3:167–71.
28. Hu S, Lin J, Zhang X. Pelvic actinomycosis in a pregnant woman misdiagnosed as placental implan­tation. J Ultrasound Med. 2020;39(9):1865–7.
29. Browne FJ, editor. Antenatal and postnatal care. 6th ed. London: J.A.Churchill Ltd; 1946. p.458.
30. Fraser R.Pyosalpinx complicating ectopic gestation. Can Med Assoc J. 1916;6:1101–4.
31. Malan D.A ten weeks' pregnancy complicated by rupture of an acute left-sided pyosalpinx. Proc R Soc Med. 1926;19:25–6.
32. Mosinger FH.Fruhinsholz, Hamant, Mosinger. Bull Soc Obstét Gynéc (Paris). 1929;18:150.
33. Ravina D. Salpingite aiguë et. Bull Soc Obstét Gynéc (Paris). 1937;26:404–6.
34. Bidoire A.Salpingite aiguë et grossesse. Bull Soc Obstét Gynéc (Paris). 1939;28:62–4.
35. Brindeau A. Salpingitis and pregnancy. Bull Soc Obstét Gynéc (Paris). 1939;28:470.
36. Metzeger M.Salpingite et grossesse. Bull Soc Obstét Gynéc (Paris). 1939;28:470–3.
37. Lennon G. The rarer causes of abdominal pain in pregnancy. Proc R Soc Med. 1950;43:105–8.
38. Evans L.Rupture of a pyosalpinx associated with an intra-uterine pregnancy. Proc R Soc Med. 1955;48:1090.
39. Auvray. Salpingite purulente et grossesse. Bull Soc Obstét Gynéc (Paris). 1925;14:34–40.
40. Öhman K.Ein Fall von Pyovarium nach dem Partus. Zentralbl f Gynäk. 1913;37:1033–6.
41. http://www.biusante.parisdescartes.fr/histoire/
images/index.php?mod=s&tout=auguste+brindeau.
42. Brindeau A.Salpingo-ovarites compliquant la gros­sesse. Arch Mens d Obst et de Gynec. 1917;9:1–33.
43. Bourne A. Acute puerperal salpingo-peritonitis. Proc R Soc Med. 1921;14:307–14.
44. Fruhinsholz H, Mosinger. No title. Bull Soc Obstét Gynéc (Paris). 1929;18:150.
References
https://t.me/medicina_free
353
45. Devraigne R.Salpingite aiguë et gestation. Bull Soc Obstet Gynec Paris. 1937;26:404–6.
46. Metzeger M.Salpingite et grossesse. Bull Soc Obstét Gynéc (Paris). 1939;28:472–5.
47. Aitken L.Remarks on pelvic peritonitis and pelvic cellulitis, with illustrative case. Trans Edinb Obstet Soc. 1870;2:77–107.
48. Coe H. Acute oophoritis complicating pregnancy. Am Gynecol J. 1891:670–2.
49. Tenani O.No title. Clin Obstet. 1929;21:21.
50. Pomini F. Rottura di ascesso ovarico intrapar­tum; peritonite acuta. Atti Soc Ital Ostet e Gynec. 1939;35:202–5.
51. Friedman MLSB. Pelvic inammatory disease in pregnancy. A review of the literature and report of 5 cases. Obstet Gynecol. 1959;14:417–25.
52. Liberty G, Hyman JH, Margalioth EJ. Peri­implantation pelvic inammatory disease with normal pregnancy outcome. Fertil Steril. 2007;88(969):e1–2.
53. Acquavella A, Rubin A, D’Angelo L.The coinci­dent diagnosis of pelvic inammatory disease and pregnancy: are they compatible? J Pediatr Adolesc Gynecol. 1996;9(3):129–32.
54. Marcinkowski KA, Mehta V, Mercier R, Berghella V.Pelvic inammatory disease in pregnancy: a sys­tematic review focusing on perinatal outcomes. Am J Obstet Gynecol MFM. 2022;4(4):100643.
55. Yalcinkaya T, Erman-Akar M, Jennell J.Term deliv­ery following transvaginal drainage of bilateral ovar­ian abscesses after oocyte retrieval: a case report. J Reprod Med. 2011;56(1–2):87–90.
56. Sherer BM, Schwartz BM, Abulaa O.Management of pelvic abscess during pregnancy: a case and review of literature. Obstet Gynecol Surv. 1999;54:655–62.
57. Blanchard JG, Pastorek JG 2nd, Weeks T. Pelvic inammatory disease during pregnancy. South Med J. 1987;80:1363–5.
58. Dudley F, Lee F, Barclay D.Ovarian and tubo­ovarian abscess in pregnancy: report of the case and a review of the literature. Mil Med. 1970;135:403–6.
59. Chen ST, Ho ES, etal. Tuboovarian abscess in preg­nancy. Taiwan J Obstet Gynecol. 2008;47:370–1.
60. Han C, Wang C, Liu XJ, Geng N, Wang YM, Fan AP, etal. In vitro fertilization complicated by rupture of tubo-ovarian abscess during pregnancy. Taiwan J Obstet Gynecol. 2015;54:612–6.
61. Abdou R, Miller T. Postpartum tubo-ovarian abscess, likely arising from pelvic inamma­tory disease during pregnancy. BMJ Case Rep. 2017;2017:bcr2017220183.
62. Brandão P, Portela-Carvalho AS, Estevinho C, Soares E, Melo A. Tubo-ovarian abscess in early pregnancy—report of a rare coexistence. Obstet Gynaecol Case Rev. 2018;5:115.
63. Craggs E, De Vogelaere K, et al. Enterobius ver­micularis infection with tuboovarian abscess and peritonitis occurring during pregnancy. Surg Infect (Larchmt). 2009;10:545–7.
64. Andrikopulou M, Apostol DOR, Becker A, Nezhat FR. Tubo-ovarian abscess in second trimester of pregnancy after transvaginal oocyte retrieval: chal­lenges in management. Int Arch Urol Complicat. 2016;2:16.
65. Lucksom PG, Thatal A, Rai P, Thakkar SN, Niranjan KS. Severe PID with sub-acute intestinal obstruc­tion during third trimester of pregnancy: a rare pre­sentation. Int J Reprod Contracept Obstet Gynecol. 2019;8:754–7.
66. Patounakis G, Krauss K, Nicholas SS, Baxter JK, Rosenblum NG, Berghella V.Development of pelvic abscess during pregnancy following transvaginal oocyte retrieval and in vitro fer­tilization. Eur J Obstet Gynecol Reprod Biol. 2012;164:16–7.
67. Kim YA, Chun KC, Koh JW, Song HS, Kim HS. How to approach the rupture of tubo-ovar­ian abscess during pregnancy: a case report and literature review. J Obstet Gynaecol Res. 2021;47(3):1199–203.
68. Ashkenazi J, Dicker D, etal. Acute pelvic inam­matory disease after oocyte retrieval: adverse effects on the results of implantation. Fertil Steril. 1994;61:526–8.
69. Moini K, Riazi K, Amid V.Endometriosis may con­tribute to oocyte retrieval-induced pelvic inamma­tory disease: report of eight cases. Iran J Reprod Med. 2004;2:40–2.
70. Bennett JJ, Cheng WC, Parsons JSW.Complications of transvaginal ultrasound-directed follicle aspira­tion: a review of 2670 consecutive procedures. J Assist Reprod Genet. 1993;10:72–7.
71. Dicker J, Feldberg D, et al. Severe abdominal complications after transvaginal ultrasonographi­cally guided retrieval of oocytes for in vitro fertilization and embryo transfer. Fertil Steril. 1993;59:1313–5.
72. Arora SK.Pregnancy with ovarian abscess. J Obstet Gynecol India. 2005;55:181–2.
73. Pabuccu S, Atabekoglu C, Sonmezer M.Early preg­nancy loss following laparoscopic management of ovarian abscess secondary to oocyte retrieval. Int J Fertil Steril. 2014;8:341–6.
74. Koehn R.Ovarian abscess complicating pregnancy. US Armed Forces Med J. 1957;8:1664–9.
75. Baydoun AB, Sarram M.Ovarian abscess in preg­nancy. Obstet Gynecol. 1961;18:739–43.
76. Cummin R. Ovarian abscess during pregnancy. J Obstet Gynaecol Br Commonw. 1951;58:1025–7.
77. Vimala N, Mittal S, etal. Primary ovarian abscess in pregnancy. JK Sci. 2004;6:40–2.
78. Gedeon G.Pregnancy at term following surgery of ovarian abscess. Magy Noorv Lapja. 1952;15:86–8.
79. Kelada E, Ghani R.Bilateral ovarian abscesses fol­lowing transvaginal oocyte retrieval for IVF: a case report and review of literature. J Assist Reprod Genet. 2007;24:143–5.
80. Myers E, Alrenga DP, etal. Ovarian abscess in mid­trimester. Colo Med. 1980;77:133–4.
354
https://t.me/medicina_free
13 Complicated Pelvic Inammatory Disease
81. Jahan T, Powell M. Laparoscopic management of an ovarian abscess complicating in-vitro fertilisation pregnancy. J Obstet Gynaecol. 2003;23:324.
82. Fung SF, Fung HY. Intramyometrial abscess com­plicating pregnancy. A report of two cases. J Reprod Med. 1998;43:1002–4.
83. Sauer C, Parsons M.Uterine horn abscess compli­cating pregnancy. Am J Perinatol. 1986;3:187–8.
84. DeLee J, editor. The principles and practice of obstetrics. 7th ed. Philadelphia: Saunders; 1938. p.601.
85. James JM, Williams RP.Attachment of gonococci to sperm inuence of physical and chemical factors. Br J Vener Dis. 1976;52:128–35.
86. Govaerts F, Delbaere A, etal. Short-term medical complications of 1500 oocyte retrievals for invitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol. 1998;77:239–43.
87. Sharpe AJ, Claman P, Suh KNKK. Transvaginal oocyte retrieval for invitro fertilization complicated by ovarian abscess during pregnancy. Fertil Steril. 2006;86:219.e11–3.
88. El-Shawarby RA, Trew GH, Lavery SA.A review of complications following transvaginal oocyte retrieval for in-vitro fertilization. Hum Fertil (Camb). 2004;7:127–33.
89. Serour M, Mansour R, etal. Complications of medi­cally assisted conception in 3,500 cycles. Fertil Steril. 1998;70:638–42.
90. Meldrum D.Antibiotics for vaginal oocyte aspira­tion. J In Vitro Fert Embryo Transf. 1989;6:1–2.
91. Evers JF, Gnany GG, Seick UV.Complications and problems in transvaginal sector scan guided follicle aspiration. Fertil Steril. 1998;49:278–82.
92. Borlum SKM. Transvaginal oocyte aspiration and pelvic infection. Lancet. 1998;2:53–4.
93. Younis Y, Laufer N, Ohel GJE.Late manifestation of pelvic abscess following oocyte retrieval, for invitro fertilization, in patients with severe endometriosis and ovarian endometrioma. J Assist Reprod Genet. 1997;14:343–6.
94. den Boon CE, Nagel HT, van Roosmalen JJK.Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report. Hum Reprod. 1999;14:2402–3.
95. Kubota K, Takeuchi HTI. A study of tubo-ovar­ian and ovarian abscesses, with a focus on cases with endometrioma. J Obstet Gynaecol Res. 1997;23:421–6.
96. Padilla S. Ovarian abscess following puncture of an endometrioma during ultrasound-guided oocyte retrieval. Hum Reprod. 1993;8:1282–3.
97. Yaron MR, Samuel D, etal. Infected endometriotic cysts secondary to oocyte aspiration for in-vitro fer­tilization. Hum Reprod. 1994;9:1759–60.
98. Dicker JA, Feldberg D, etal. Transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before ovulation induction for invitro fertilization. J In Vitro Fert Embryo Transf. 1991;8:286–9.
99. Suganuma Y, Ishida D, etal. Pretreatment for ovar­ian endometrial cyst before in vitro fertilization. Gynecol Obstet Investig. 2002;54(Suppl 1):36–40.
100. Tsai MY, Chen SH, etal. Vaginal disinfection with povidone iodine immediately before oocyte retrieval is effective in preventing pelvic abscess formation without compromising the outcome of IVF-ET. J Assist Reprod Genet. 2005;22:173–5.
101. Vigano P, Corti L, Berlanda N. Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis. Fertil Steril. 2015;104(4):802–12.
102. Horikawa T, Nakagawa K, Ohgi S, Kojima R, Nakashima A, Ito M, etal. The frequency of ovu­lation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle. J Assist Reprod Genet. 2008;25(6):239–44.
103. Medicine PC of the AS for R. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591–8.
104. Dunselman G, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, etal. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–12.
105. Matsunaga K, Nozaki M, etal. A case of pregnancy complicated by the development of a tubo-ovarian abscess following invitro fertilization and embryo transfer. Am J Perinatol. 2003;20:277–82.
106. Jafari J, Webster A, Stepto RC, etal. Tubo-ovarian abscess in pregnancy. Acta Obstet Gynecol Scand. 1977;5:1–4.
107. Kim JW, Lee WS, Yoon TK, Han JE.Term delivery following tuboovarian abscess after invitro fertil­ization and embryo transfer. Am J Obstet Gynecol. 2013;208:e3–6.
108. Davey MM, Guidozzi FG. Ruptured tubo-ovarian abscess late in pregnancy: a case report. S Afr Med J. 1987;71:120–1.
109. Scott DJH.Acute salpingitis and pregnancy. J Obstet Gynaecol Br Emp. 1954;61:788–92.
110. Navada MN, Bhat BPR.Pelvic inammatory dis­ease in the form of peritoneal abscess complicat­ing late pregnancy. Case Rep Obstet Gynecol. 2011;2011:851598.
111. Donaldson I. Pelvic tuberculosis and pregnancy. BMJ. 1952;2:128–30.
112. Abalde F, Guerrero A, et al. Streptococcus pneumoniae peritonitis secondary to a tubo­ovarian abscess. Eur J Clin Microbiol Infect Dis. 1998;17:671–3.
113. Eperon C, Irion O, et al. Neonatal pneumococ­cal sepsis associated with maternal tubo-ovarian abscess. J Obstet Gynaecol. 2013;33:416–7.
114. Aitken L.Remarks on pelvic peritonitis and pelvic cellulitis, with illustrative case. Tran Edinb Obstet Soc. 1870;2:77–107.
115. Levgur M, Duvivier R.Pelvic inammatory disease after tubal sterilization: a review. Obstet Gynecol Surv. 2000;55:41–50.
References
https://t.me/medicina_free
355
116. Orr J, Younger JB. Infected Mullerian anomaly: unusual cause of pelvic abscess during pregnancy. Am J Obstet Gynecol. 1986;155:368–70.
117. Dogan E, Saatli B, et al. Tuba ovarian abscesses formation from decidualized ovarian endometri­oma after appendiceal endometriosis presenting as acute appendicitis in pregnancy. Iran J Reprod Med. 2012;10:275–8.
118. Bracha M, Zakut HJL. Ovarian abscess follow­ing cesarean section. A case report and review of the literature. Clin Exp Obstet Gynecol. 1988;15:134–6.
119. Martino JR, Bryan PJCH. Secondary infection of an endometrioma following ne-needle aspiration. Radiology. 1984;151:53–4.
120. Howe C, Mastroianni Jr L, et al. Pelvic infection after transvaginal ultrasound-guided ovum retrieval. Fertil Steril. 1998;49:726–8.
121. Scoccia I, Brandt TBM. Uterine abscess after ultrasound-guided ovum retrieval in an in vitro fertilization–embryo transfer program: case report and review of the literature. J Assist Reprod Genet. 1992;9:285–9.
122. Coroleu F, Hereter L, etal. Ureteral lesion secondary to vaginal ultrasound follicular puncture for oocyte recovery in in-vitro fertilization. Hum Reprod. 1997;12:948–50.
123. Roest HV, Zeilmaker GH, Verhoeff AJM.The inci­dence of major clinical complications in a Dutch transport IVF program. Hum Reprod Update. 1996;2:345–53.
124. Zweemer F, Verheijen RHRS. Ovarian abscess during pregnancy mimicking a leiomyoma of the uterus: a complication of transvaginal ultrasound­guided oocyte aspiration. J Assist Reprod Genet. 1996;13:81–5.
125. Biringer P, Visnovsky J, Danko JKZ.Delayed deliv­ery following unusual are-up pelvic abscess after in vitro fertilization and embryo transfer. Fertil Steril. 1956;2009(91):e5–7.
126. Acosta CR, Kaufman RH. Intrauterine pregnancy and coexistent pelvic inammatory disease. Obstet Gynecol. 1971;37:282–5.
127. Al-Kuran S, Al-Mehaisen LOB. Pelvic abscess complicating an in vitro fertilization pregnancy and review of the literature. J Assist Reprod Genet. 2008;25:341–3.
128. Friedler I, Abramov Y, etal. Ruptured tubo-ovarian abscess complicating transcervical cryopreserved embryo transfer. Fertil Steril. 1996;65:1065–6.
129. Curtis N, Keith E, etal. Evaluation of the risk of pel­vic infection following transvaginal oocyte recovery. Hum Reprod. 1991;6:1294–7.
130. Geissdörfer C, Pelz K, et al. Tuboovarian abscess caused by Atopobium vaginae following transvaginal oocyte recovery. J Clin Microbiol. 2003;41:2788–90.
131. Chayachinda A, Ruangvutilert P, Thamkhantho MCL. Postpartum, post-sterilization tubo-ovarian abscess caused by fusobacterium necrophorum: a case report. J Med Case Rep. 2012;6:330.
132. Stubbs RE, Monif GRG. Ruptured tubo-ovarian abscess in pregnancy: recovery of a penicillinase­producing strain of Neisseria gonorrhoeae. Sex Transm Dis. 1985;12:235–7.
133. Dashow R, BeMiller DEC. Ruptured tuboovarian abscess in early gestation. A case report. J Reprod Med. 1990;35:418–9.
134. Erdem M, Yazici G, et al. Incidental tubo-ovarian abscess at abdominal delivery: a case report. J Matern Fetal Neonatal Med. 2002;12:279–80.
135. Ragu N, Tichoux C, Bouyabrine H, Carabalona J, Taourel P, Bruel J, etal. Complicated diverticulitis during pregnancy. J Radiol. 2004;85(11):1950–2.
136. Sherer D, Frager D, Eliakim R.An unusual case of diverticulitis complicating pregnancy at 33 weeks' gestation. Am J Perinatol. 2001;18(2):107–11.
137. Özbay SKD. Relationships between transvaginal colour Doppler ndings, infectious parameters and visual analogue scale scores in patients with mild acute pelvic inammatory disease. Eur J Obstet Gynecol Reprod Biol. 2011;156:105–8.
138. Park S, Song T, Kim YJ, Lee JE, Kim MK, Kim ML, etal. Tuboovarian abscess in pregnancy after invitro fertilization and embryo transfer. Korean J Obstet Gynecol. 2012;55(11):894–8.
139. Lee DC, Swaminathan AK. Sensitivity of ultra­sound for the diagnosis of tubo-ovarian abscess: a case report and literature review. J Emerg Med. 2011;40:170–5.
140. Son SY, Wu E, Gariwala V, O'Neill C. Mesenteric ectopic pregnancy with tubo-ovarian abscess. Radiol Case Rep. 2021;16(5):1165. /pmc/articles/ PMC7985701/.
141. Lee HJ, Kim YH, Kim JW, Song TB, Lee KH. A case of tubo-ovarian abscess in a pregnant woman. Korean J Obstet Gynecol. 2012;55(11):843–7.
142. Tukeva HJ, Karjalainen PT, etal. MR imaging in pelvic inammatory disease: comparison with lapa­roscopy and US.Radiology. 1999;210:209–16.
143. Cunningham JC, Gilstrap LC, et al. The bacterial pathogenesis of acute pelvic inammatory disease. Obstet Gynecol. 1978;52:161–4.
144. Sweet DL, Schachter J, et al. Microbiology and pathogenesis of acute salpingitis as determined by laparoscopy: what is the appropriate site to sample. Am J Obstet Gynecol. 1980;138:958–89.
145. Sweet J, Hadley WK, et al. Use of laparos­copy to determine the microbiologic etiology of acute salpingitis. Am J Obstet Gynecol. 1979;134:68–74.
146. Haas DM, Morgan S, Contreras K, Enders S.Vaginal preparation with antiseptic solution before cesar­ean section for preventing postoperative infections. Cochrane Database Syst Rev. 2018;4:CD007892.
147. Ibara P, Le Martelot MT, etal. Two cases of systemic Candida glabrata infection following invitro fertil­ization and embryo transfer. Eur J Clin Microbiol Infect Dis. 2004;23:53–6.
148. Ross J, Guaschino S, Cusini M, Jensen J. 2017 European guideline for the management of pel-
356
https://t.me/medicina_free
13 Complicated Pelvic Inammatory Disease
vic inammatory disease. Int J STD AIDS. 2018;29(2):108–14.
149. Edelstein S, Ben Shachar I, Ben-Amram H, Biswas S, Marcus N. Assisted reproductive technology as a transcutaneous route for bacterial contamination of ovarian endometrioma with coagulase-negative staphylococcus: case report and review of the litera­ture. Infect Dis Obstet Gynecol. 2019;2019:4149587.
150. Goharkhay U, Maggiorotto FNV. Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo-ovarian abscesses. Ultrasound Obstet Gynecol. 2007;29:65–9.
151. Kinay E, Cirik DATU.The value of ultrasonographic tubo-ovarian abscess morphology in predicting whether patients will require surgical treatment. Int J Gynaecol Obstet. 2016;135(1):77–81.
152. El-Agwany AS, Fouad AM. Partial wound dehis­cence after midline laparotomy: a complication after tubo-ovarian abscess evacuation with pregnancy. Arch Perinat Med. 2014;20:229–31.
153. Yalcin HM, Eskalen MOT. Unruptured pelvic abscess in pregnancy: report. Gynecol Obstet Investig. 2002;53:133–4.
154. Kuo SY, Liu TC, et al. Clinical characteristics and treatment outcomes of patients with tubo-ovarian abscess at a tertiary care hospital in northern Taiwan. J Microbiol Immunol Infect. 2012;45:58–64.
155. Lowne WLRK. Ruptured tuboovarian abscess at the seventh month of uterus gestation. Am J Obstet Gynecol. 1951;62:454–5.
156. Piegzová A, Unzeitig V. Tubo-ovarian abscess in the 39th week of pregnancy (case report). Ceska Gynekol. 2017;82:322–6.
157. Feuillade F. Genital tuberculosis and pregnancy. Bull Soc Obstét Gynéc (Paris). 1924;13:683.
158. Nkwabong E; Fomulu JN etal. Tubo-ovarian abscess during pregnancy: a case report. Int J Gynecol Obstet 2013;17(2).
159. Lareau SM, Beigi RH.Pelvic inammatory disease and tubo-ovarian abscess. Infect Dis Clin N Am. 2008;22:693–708.
160. Huang CC, Huang CC, Lin SY, Chang CYY, Lin WC, Chung CH, etal. Association of pelvic inam­matory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: a nationwide population­based retrospective cohort study. PLoS One. 2019;14(8):e0219351.
161. Nader S, Barrans A, et al. Streptococcus pneu­moniae neonatal infection. Ann Biol Clin. 2005;63:643–6.
162. Hoffman EO, Schutze GE, et al. Streptococcus pneumoniae infections in the neonate. Pediatrics. 2003;112:1095–102.
163. Gedeon G.Pregnancy at term following surgery of ovarian abscess. Magy Noorv Lapja. 1952;3:86–8.
164. Stitely RB, Gherman M. Successful pregnancy outcome following rst trimester pelvic inam­matory disease. Aust N Z J Obstet Gynaecol. 2000;40:200–2.
165. McDonald K, Snyder JLB.Peripartum transmission of penicillin-resistant Streptococcus pneumoniae. J Clin Microbiol. 2003;41:2258–60.
166. Ács N, Bánhidy F, Puhó EH, Czeizel AE.Possible association between acute pelvic inammatory disease in pregnant women and congenital abnor­malities in their offspring: a population-based case­control study. Birth Defects Res A Clin Mol Teratol. 2008;82(8):563–70.
167. Yip PJ, Bock BFLS. Acute suppurative salpingi­tis with concomitant intrauterine pregnancy. Am J Emerg Med. 1993;11:476–9.
168. Orvieto Z, Abir R, etal. Controlled ovarian hyper­stimulation: a state of neutrophil activation. Am J Reprod Immunol. 1999;42:288–91.
169. Kepkep YA, Yigitbasi RKT.Nocardial tubo-ovarian abscess in a pregnant woman: a rare case report. Aust N Z J Obstet Gynaecol. 2006;46:363–5.
Vernix Caseosa Peritonitis
https://t.me/medicina_free
14
Abstract
Vernix caseosa (VC) peritonitis is an extremely rare, poorly recognized complica­tion caused by an inammatory response to amniotic uid spilled into the maternal peri­toneal cavity. Two classic forms are recog­nized: VC peritonitis and VC granuloma. The third form is meconium peritonitis/granu­loma. Meconium, apart from detritus and digestive tract secretions, also contains ingested amnion with lanugo hair. With fetal distress, the fetal intestine empties. VC com­plications present during the rst postpartum days with abdominal pain and pyrexia. Nausea, vomiting, and dyspnea due to dia­phragmatic irritation are common. Contrast­enhanced abdominal CT reveals multiple oval rim-enhancing peritoneal lesions commonly misinterpreted. Nonoperative treatment includes antibiotics and steroids with a low success rate. Surgical treatment includes
lavage with the removal of all masses. Incorrect preoperative diagnosis results in removing many intra-abdominal organs commonly attributed to malignancy. Maternal survival is excellent, but the sequel is com­mon with operative and nonoperative treatment.
14.1 Denition andHistorical
Perspective
Vernix caseosa peritonitis (VCP) is an extremely rare, poorly recognized complication caused by an inammatory response to amniotic uid spilled into the maternal peritoneal cavity. The term ver- nix caseosa (VC) rst appeared in 1846 in the Dunglison Dictionary of Medical Sciences. The rst description of the term VCP was by Martin S.Krumerman and Gerald J.Pouliot in 1976 after the Cesarean section (CS) [1]. It was an unre­ported complication before the era of CS.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 G. Augustin, Acute Abdomen During Pregnancy, https://doi.org/10.1007/978-3-031-26021-6_14
357
358
https://t.me/medicina_free
14 Vernix Caseosa Peritonitis
14.2 Incidence
Less than 40 cases of VCP have been reported to date [2–6]. However, the incidence of VCP is undoubtedly underestimated because many cases with mild symptoms likely go unnoticed.
14.3 Pathology
14.3.1 Physiology ofVernix Caseosa
Birth is a state of rapid transition from the high­humidity aqueous intrauterine environment to the characteristically low-humidity (typically 20–40%) extrauterine environment. VC is the cheese-like substance covering the skin of the newborn, unique to humans during the last trimester of pregnancy, unique to humans. This material in the amniotic uid consists of an admixture of (1) fetal desqua­mated, anucleate, squamous, epithelial cells, (2) lanugo hair shafts, and (3) sebaceous glandular secretion. Biochemical studies have revealed the presence of lipids (62.5%), proteins (36%), and carbohydrates (1.5%) [7]. After delivery, VC dries spontaneously on the skin. VC has multiple protec­tive functions such as moisturizer, anti-infective, antioxidant, and enhancer of the acid mantle devel­opment after birth [8]. VC undergoes a substantial change during birth and is transferred from an aqueous, warm, and sterile environment to a gas­eous, colder, and xenobiotic-containing environ­ment postnatally [9]. Differences exist in VC composition between newborn boys and girls. Higher proportions of wax esters and triacylglycer­ols with longer hydrocarbon chains were observed in newborn girls [10]. The gestational age was likely to affect branched-chain fatty acids concen­trations, with the VC and meconium branched­chain fatty acids content being signicantly higher in full-term infants than in preterm infants [11]. VC is more prominent following CS than after vaginal births [12]. VC is absent in very low birth weight premature infants [8].
14.3.2 Vernix Caseosa Peritonitis/
Granuloma
(Unawareness of) VC commonly results in appendectomy. Only microscopic examination demonstrates multiple brinocellular exudates on the appendiceal serosa (Fig. 14.1a). The inammatory cells include an admixture of neu­trophils, eosinophils, lymphocytes, and macro­phages aggregated about anucleate squamous cells having wrinkled borders (Fig. 14.1b). Occasionally, a foreign body giant cell reaction is present (Fig.14.1c). Besides, a lanugo hair shaft surrounded by inammatory cells can be identi­ed (Fig. 14.1d). There are intense hyperemia and hemorrhagic foci. The anucleate squamous cells show strong positivity for AE1/AE3 cyto­keratin (Fig. 14.1e). Proliferating (reactive) submesothelial spindle cells also display strong positivity for AE1/AE3 cytokeratin. The squa­mous cells are arranged as single or in groups, and the cheesy exudate is brinous.
The predominant type of inammatory cells depends on the duration of VCP.Neutrophils are predominant soon after delivery. After several days, an acute and foreign body inammatory reaction will usually be evident. Weeks after delivery, granulomatous foreign body reactions predominate [13, 14].
14.3.3 Intraperitoneal Meconium
Peritonitis/Granuloma
Differential diagnosis from maternal meconium peritonitis could be difcult due to many simi­larities. Meconium peritonitis/granuloma char­acterizes numerous eosinophils scattered irregularly throughout the process. There are many giant cells with organized epithelioid tubercles. Within these cells, vacuoles contain a yellow-brown pigmented material arranged in cords and sheets; the latter stained positive for bile [15].
14.4 Pathophysiology
https://t.me/medicina_free
359
a
b
de
c
Fig. 14.1 (a) Appendiceal biopsy shows normal mucosa, underlying muscularis propria (black arrow), and a sero­sal inammatory inltrate (blue arrows) centered around fetal squamous cells (purple arrow) (H&E; ×20) [16]; (b) Scattered anucleate squamous cells are surrounded by a mixed inammatory inltrate. The arrow indicates an anucleate squamous cell (H&E; ×200); (c) Mixed inam­matory inltrates with the presence of a multinucleated
14.4 Pathophysiology
14.4.1 Vernix Caseosa Peritonitis/ Granuloma
Spillage of VC into the peritoneal cavity incites an inammatory reaction causing symptoms resembling an acute abdomen. The leakage of amniotic uid results from the following:
• Antenatal or intrapartum tubal reux [2, 13],
• Premature rupture of membranes [17],
• Uterine perforation/rupture,
• Rupture of ovarian mature cystic teratoma,
• CS [14].
giant cell. This cell shows rests of squamous cells engulfed in its cytoplasm (H&E; ×200); (d) Lanugo hair shaft amidst inammatory cells (H&E; ×400); (e) Anucleate squamous cells and proliferating submesothelial cells show strong positivity for AE1/AE3 cytokeratin. The arrow points to an aggregate of anucleate squamous cells (Cytokeratin; ×200) [3]
Tubal reux of amniotic uid will not occur unless some disruption of the natural decidual– tubal barrier occurs or intrauterine pressure dif­ferences facilitate ow in this direction rather than through the cervix. In the normal gravid uterus of four or more months’ gestation, intact membranes, decidual hypertrophy, stromal edema, placentation, and the cervical mucus plug usually occlude the cavity [17].
Most cases were diagnosed in the postpartum period after uneventful CS.The spillage of amni­otic uid into the peritoneal cavity at CS is almost inevitable and usually insignicant. However, in some cases, it can be the trigger for a peritoneal reaction. The exact mechanism leading to the
Соседние файлы в папке @xirurgi_2025
Помощь Обратная связь Вопросы и предложения Пользовательское соглашение Политика конфиденциальности