PEER PRESENTATION

ON
“PELVIC INFLAMMATORY DISEASE”

SUBJECT: OBSTETRICS AND GYNAECOLOGICAL

NURSING

SUBMITTED TO: SUBMITTED BY:

PROF. BINITA KHATI BARSHA SHARMA
HEAD OF DEPT. OBG NURSING REGD. NO – 202263026
SIKKIM MANIPAL COLLEGE OF NURSING MSC.NURSING 2ND YEAR
 INTRODUCTION
Pelvic infection is one of the most common, serious infections in non-pregnant women or
reproductive age. Pelvic infection is usually the result of infection ascending from the
endocervix causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess
and/or pelvic peritonitis.
Pelvic Inflammatory Disease is reported to occur in 1% of the 15- 25year age group of young
adults around the world and affects around 24%–32% of women in India. In developed
countries, the annual incidence is estimated to be 10–13 per 1000 women, with 20 per 1000
women being in the age group of 20–24 years.
PELVIC INFLAMMATORY DISEASE
Pelvic inflammatory disease (PID) is a spectrum of infection and inflammation of the upper
genital tract organs typically involving the endometrium, fallopian tubes, ovaries, pelvic
peritoneum and surrounding structures.

CAUSATIVE ORGANISMS
Acute PID is usually a polymicrobial infection caused by organisms ascending from the lower
genital tract. The primary organisms are usually sexually transmitted and the secondary
organisms are those normally found in the vagina:
1. Sexually transmitted organisms:
➢ Gonococcus
➢ Chlamydia trachomatis
➢ Mycoplasma hominis.
2. Pyogenic infection causing organisms:
➢ Streptococcus
➢ Staphylococcus
➢ E. coli
➢ Actinomyces species
➢ Bacteroides species, e.g. B. fragilis and B. bivius, Pepto streptococcus and Pepto coccus.

RISK FACTORS
• Menstruating teenagers-ascending infections especially caused by Escherichia coli (E.
coli), group B Streptococcus and Staphylococcus
• Previous history of acute PID
• Use of intrauterine contraceptive devices (IUCD)
• Multiple sex partners.

TYPES OF INFECTIONS
1. Primary infection: typical infections such as C. trachomatic, N. gonorrhea
2. Secondary infection: This are further classified into;
Genito urinary:
➢ Acute endometritis
➢ Chronic endometritis
➢ Atrophic (senile) endometritis
➢ Pyometra (collection of pus in the uterine cavity).
Fallopian tubes:
➢ Acute salpingitis
➢ Chronic salpingitis.
Ovaries:
➢ Oophoritis.

PATHOGENESIS
The pathological process is initiated in the endosalpinx with gross destruction of the epithelial
cells, cilia and microvilli. In severe infection, it involves all the layers of the tube and produces
acute inflammatory reaction; becomes edematous and hyperemic. The abdominal ostium is
closed due to inflammatory adhesions. Depending upon the virulence, the exudate may be
watery producing hydro-salpinx or purulent producing pyosalpinx.
On occasions, the exudate pours through the abdominal ostium to produce pelvic peritonitis
and pelvic abscess or may affect the ovary producing ovarian abscess.
Pathogenesis of Pelvic Inflammatory Disease is classified under
• Ascending
• Hematogenous
• Local spread
Most cases of PID occur in 2 stages.
1. Acquisition of a vaginal or cervical infection, which is often sexually transmitted and may
be asymptomatic
2. Direct ascent of microorganisms from the vagina or cervix to the upper genital tract, with
infection and inflammation of these structure
3 Infection of the fallopian tubes initially affects the mucosa, but inflammation may rapidly
become transmural. This inflammation, which appears to be mediated by complement, may
increase in intensity with subsequent infections
4 Inflammation may extend to uninfected parametrial structures, including the bowel
5 Infection may extend via spillage of purulent materials from the fallopian tubes or via
lymphatic spread beyond the pelvis to produce acute peritonitis and acute perihepatitis (Fitz-
Hugh−Curtis syndrome)
Other factors responsible for influencing occurrence of PID are:
• Cervical mucus provides a functional barrier against upward spread, but vaginal inflammation
and hormonal changes that occur during ovulation and menstruation decrease the efficacy of
this barrier
• Antibiotic treatment of sexually transmitted infections can also disrupt the balance of
endogenous flora in the lower genital tract,

CLINICAL FEATURES
Symptoms usually appear at and immediately following menses in acute infections:
• Bilateral lower abdominal and pelvic pain
• Fever-temperature > 38.3°C
• Tiredness and headache
• Irregular and excessive vaginal bleeding due to endometritis
• Increased vaginal discharge usually mucopurulent
• Nausea and vomiting
• Dyspareunia and dysuria
• Dysmenorrhea
• Postcoital spotting
• Cervical motion tenderness
• Hypoactive bowel sounds
• Adnexal fullness and tenderness
• Cervical friability
• Congested vulva, urethral meatus and openings of Bartholin's ducts
• Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein
• Ultrasound evidence of fluid or pus collection.

INVESTIGATIONS
Laboratory evaluation
• Urine pregnancy test (always rule out ectopic)
• Identification of organisms from the materials collected from the affected organ
• Blood tests for white blood cells (leukocytosis and elevated ESR)
• Laparoscopic examination in severe cases
• Culdocentesis and examination of the fluid.
• Vaginal smear: Abundant WBC on vaginal smears
• Test for other infections: Syphilis, HIV
Transvaginal ultrasound
Predictor: Thickened >5 mm fluid filled tubes, indistinct borders, moderate to large fluid filled
in pouch of Douglas, multiple cysts in ovaries. Cogwheel appearance of tubes on cross section
TREATMENT
Patients with severe infection are hospitalized for management:
• Bedrest
• Restricted oral feeding
• Intravenous fluid to correct dehydration and acidosis
• Antibiotics intravenously; cefoxitin or gentamicin and metronidazole
• Draining of collected fluid or pus via laparotomy or ultrasound-guided aspiration of pelvic
fluid collections is less invasive and may be equally effective
• Nasogastric suction in the presence of ileus or abdominal distention.
Indications for Surgical Interventions-
Need for surgical intervention is rare and indicated in:
• Generalized peritonitis
• Pelvic abscess
• Tubo-ovarian abscess, which does not respond to the antimicrobial therapy for 48-72 hours.

COMPLICATIONS
With chronic PID, which is diagnosed and treated late, there is increased risk of developing
complications such as:
• Infertility
• Ectopic pregnancy
• Chronic pelvic pain.
PREVENTION
Primary prevention:
• Patient education and Opportunistic screening
• Avoid multiple sexual partners
• Use of condom during sexual intercourse
• Have follow up smears and culture tested
Secondary prevention:
• Adherence of compliance to treatment
• Follow up of treatment
• Tracing of partner and partner treatment
• Completion of entire antibiotic course
NURSING MANAGEMENT
Nursing management of pelvic inflammatory disease (PID) involves several key components
aimed at effectively treating the infection, alleviating symptoms, preventing complications, and
providing support to the patient. Here's an overview of nursing management for PID:
1. Assessment and Diagnosis:
➢ Nurses play a crucial role in collecting thorough medical histories, including sexual history
and risk factors.
➢ They assist in performing physical examinations to identify signs and symptoms of PID,
such as lower abdominal tenderness, cervical motion tenderness, and abnormal vaginal
discharge.
➢ Nurses may also facilitate diagnostic tests such as pelvic ultrasound, endometrial biopsy,
and laboratory tests (e.g., complete blood count, cultures for sexually transmitted
infections).
2. Medication Management:
➢ Nurses educate patients about prescribed medications, including antibiotics to treat the
underlying infection. They provide detailed instructions on dosage, frequency, and potential
side effects.
➢ They monitor the patient's response to treatment, assessing for resolution of symptoms and
adverse reactions to medications.
➢ Nurses reinforce the importance of completing the full course of antibiotics, even if
symptoms improve.
3. Pain Management:
➢ Nurses assess the patient's pain level and implement appropriate pain management
strategies, such as administering analgesics and applying heat therapy to the lower
abdomen.
➢ They teach relaxation techniques and positioning methods to help alleviate discomfort.
4. Education and Counseling:
➢ Nurses provide comprehensive education about PID, including its causes, risk factors,
symptoms, complications, and prevention strategies.
➢ They offer counseling and support regarding safe sexual practices, contraception, and the
importance of regular screenings.
➢ Nurses address concerns related to fertility, sexual health, and the potential impact of PID
on future pregnancies.
5. Follow-up and Monitoring:
➢ Nurses schedule follow-up appointments to assess the patient's progress, monitor for
treatment response, and evaluate for potential complications.
➢ They encourage adherence to follow-up care and assist with arranging additional diagnostic
tests or referrals as needed.
➢ Nurses provide ongoing support and counseling to promote physical and emotional well-
being.
6. Preventive Measures:
➢ Nurses advocate for preventive measures such as vaccination against sexually transmitted
infections (e.g., HPV vaccine) and regular screening for STIs.
➢ They emphasize the importance of practicing safer sex behaviors, including condom use
and mutual monogamy, to reduce the risk of recurrent PID and other STIs.

CONCLUSION
Pelvic inflammatory disease (PID) is a serious infection of the female reproductive organs,
typically caused by sexually transmitted bacteria. Its conclusion varies depending on prompt
diagnosis and appropriate treatment. Untreated PID can lead to complications like chronic
pelvic pain, infertility, and ectopic pregnancy. With proper medical care, including antibiotics,
the majority of cases can be resolved, although some long-term effects may persist. Regular
check-ups and safe sexual practices are essential for prevention and early detection.
In severe cases, PID can result in abscess formation or scarring of the fallopian tubes,
increasing the risk of complications. If left untreated, PID can lead to chronic pain, fertility
issues, and an increased risk of ectopic pregnancy or pelvic inflammatory-related infertility.
However, with timely diagnosis and appropriate treatment, such as antibiotics, most cases of
PID can be effectively managed and long-term complications can be minimized. Follow-up
care and preventive measures, such as practicing safe sex and regular screenings, are crucial
for managing and preventing recurrent episodes of PID.

BIBLIOGRAPHY
1. Jacob, Annamma (2012) Comprehensive Textbook of Midwifery and Gynecological
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638-642
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Toronto, ON: Elsevier Canada.
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