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Purulent gynecological diseases
Last reviewed: 23.04.2024
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Inflammatory diseases of the genital organs, constituting 60-65% among outpatients and up to 30% among inpatients, are one of the main medical problems and have a significant impact on the health of millions of women of childbearing age.
In recent years, the growth of inflammatory diseases of the genitalia in all countries of the world has increased by 13% in the general population of women of the reproductive period and by 25% in women with IUD, and the frequency of tubo-ovarian inflammatory etiology increased three times. According to research, their share in the structure of all forms of inflammation of the genitals was 27%.
Unfortunately, it should be noted that in the domestic literature there are practically no statistical data on the frequency of purulent diseases in the regions, and in Ukraine as a whole.
According to some data, in the structure of gynecological hospitals providing emergency care, inflammation of the internal genital organs ranges from 17.8 to 28%.
According to doctors, 1 million American women suffer from inflammatory diseases of the pelvic organs every year.
The incidence of pelvic inflammatory disease is 49.3 per 10,000 women. Inflammatory diseases not only occupy a leading position in the structure of gynecological morbidity, but are the most frequent cause of hospitalization of women of reproductive age and create major medical, social and economic problems throughout the world.
The inflammatory process and its consequences often irreversibly mutilate not only the reproductive, but also the nervous system, affecting to a large extent the psychoemotional status of patients.
Even the effects of banal salpingitis remain quite serious: infertility and ectopic pregnancy.
Research data shows that 15% of patients with pelvic inflammatory diseases do not respond to treatment, 20% have at least one relapse, and 18% will become infertile.
It has been revealed that 15% of patients with inflammatory diseases of the pelvic organs require hospitalization, more than 20% may subsequently become infertile and at least 3% will be threatened with an ectopic pregnancy.
Scientists retrospectively studied the three-year effects of acute inflammation of the uterus: 24% of patients suffered from pelvic pain for 6 months or more after treatment, 43% had exacerbations of the inflammatory process and 40% were infertile.
Chronic anovulation as a result of the inflammatory process may subsequently lead to the occurrence of tumor growth.
According to observations, patients with inflammatory disease of the pelvic organs are 10 times more likely than healthy ones, chronic pain syndrome is observed, 6 times more often - endometriosis, they are 10 times more often operated on for ectopic pregnancy and 8 times more often than in the population, the uterus is removed.
Inflammatory purulent tubo-ovarian formations represent a danger to the life of the patient, especially if they are complicated by sepsis. Mortality of patients with purulent diseases of internal genital organs, according to foreign authors, is 5-15%.
An important factor is the economic costs associated with the disease itself and its consequences.
According to G.Newkirk (1996), every tenth woman in the USA has reproductive pelvic organs during the reproductive age, and every fourth of them has some serious complications. The medical costs of treating the disease and its consequences, including infertility, ectopic pregnancy or chronic pain, are more than $ 5 billion annually.
Acute inflammatory diseases of the pelvic organs are the main gynecological problem of the health of women of childbearing age in the United States: accounting for the direct and indirect costs of more than one million patients who are forced to consult gynecologists every year, M.Quan (1994) cites a figure in excess of $ 4.2 billion.
In connection with the increase in the incidence of costs associated with the treatment of inflammatory diseases, should be in the United States by 2010 about 10 billion dollars.
However, in recent years, positive trends have been noted in a number of countries in reducing the severity of this problem.
Preventive measures aimed at combating gonorrheal and chlamydial infection, together with improved diagnosis and treatment, have reduced the incidence of pelvic inflammatory diseases of specific etiology and their serious complications.
There are reports that over the past 20 years, remarkable advances in the treatment of tubo-ovarian abscesses, including a significant reduction in mortality, have been witnessed. Despite the fact that surgical intervention is still necessary in 25% of cases, the combined use of conservative and surgical methods (for example, unilateral adnexectomy and the use of broad-spectrum antibacterial drugs) reduced the need for hysterectomy.
However, the frequency and severity of purulent inflammatory diseases and their complications, including infertility, numerous intrauterine infections and, possibly, deaths from ectopic pregnancy, perforation of tubo-ovarian abscesses, as well as the risk of a combined defeat by the immunodeficiency virus and the hepatitis B virus, make it necessary to search for new effective methods of their treatment.
Causes of purulent gynecological diseases
The basis of the development and formation of inflammatory diseases is a set of interrelated processes, ranging from acute inflammation to complex destructive tissue changes.
The main trigger for the development of inflammation, of course, is microbial invasion (microbial factor).
On the other hand, in the etiology of the purulent process, so-called provoking factors play a significant and sometimes decisive role. This concept includes physiological (menstruation, childbirth) or iatrogenic (abortion, IUD, hysteroscopy, hysterosalpingography, surgery, IVF) weakening or damage of barrier mechanisms, which contributes to the formation of the entrance gate for pathogenic microflora and its further spread.
In addition, it is necessary to emphasize the role of background diseases and other risk factors (extragenital diseases, some bad habits, certain sexual inclinations, socially determined conditions).
Analysis of the results of numerous bacteriological studies in gynecology performed over the past 50 years has revealed a change of microbes - the causative agents of such diseases over the years.
Causes of purulent gynecological diseases
[Pathogenesis of purulent gynecological diseases
Currently, inflammatory diseases of the pelvic organs are of multimicrobial origin, based on the complex interaction between synergistic infectious agents.
The female body, unlike the male, has an open abdominal cavity, which through the vagina, cervical canal, uterine cavity and fallopian tubes communicate with the external environment, and under certain conditions the infection can penetrate into the abdominal cavity.
Two pathogenesis variants are described: the first is upward flora infection of the lower parts of the genital tract, the second is the spread of microorganisms from extragenital foci, including from the intestine.
At present, the theory of the ascending (intracanalicular) route of infection prevails.
Damaged tissues (micro and macrodamages during invasive interventions, operations, childbirth, etc.) are the entrance gate of the infection. Anaerobes penetrate from the neighboring ecological niches of the mucous membranes of the vagina and the cervical canal, and also partly from the colon, external genital organs, skin; multiply, spread and condition the pathological process. The ascending pathway of infection is also characteristic of other forms of microorganisms.
Pathogenesis of purulent gynecological diseases
Diagnosis of purulent gynecological diseases
Peripheral blood counts reflect the severity of the inflammatory process and the depth of intoxication. So, if in the stage of acute inflammation, characteristic changes are leukocytosis (mainly due to stab and young forms of neutrophils) and increased ESR, then during remission of the inflammatory process, first of all, attention is paid to the decrease in the number of erythrocytes and hemoglobin, lymphopenia with normal neutrophilic formula and increase in ESR.
Objective laboratory criteria for the severity of intoxication are considered a combination of laboratory parameters such as leukocytosis, ESR, the amount of protein in the blood, the level of medium molecules.
A mild degree of intoxication is typical for patients with a short process and uncomplicated forms, and a severe and moderate degree is typical for patients with so-called conglomerate tumors with a remitting course and requiring long-term conservative treatment.
The clinical course of the purulent process is largely determined by the state of the immune system.
Diagnosis of purulent gynecological diseases
Treatment of purulent gynecological diseases
The tactics of management of patients with purulent inflammatory diseases of the pelvic organs is largely determined by the timeliness and accuracy of diagnosis of the nature of the process, the extent of its spread and the assessment of the real risk of developing purulent complications, while the clinical approach is the most important and the final goal is the timely and complete elimination of this process. Also prevention of complications and recurrences.
That is why the value of the correct, and most importantly, timely diagnosis in these patients is difficult to overestimate. The concept of diagnosis of purulent lesions (clinically well thought out and instrumentally proven determination of the stages of the process localization and the stage of suppuration) should be the basis of successful treatment.
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