Theraps - Pelvic Inflammatory Disease

Homoeopathic Therapeutics for clinical condition in gynaecology, Pelvic Inflammtory Disease.

1. THERAPEUTICS – PELVIC INFLAMMATORY DISEASE (PID) DR. D. Y. PATIL HOMOEOPATHIC MEDICAL COLLEGE AND RESEARCH CENTRE DR. RADHIKHA KHANDELWAL DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

2. DEFINITION PID is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures . It is attributed to the ascending spread of microorganisms from the cervicovaginal canal to the contiguous pelvic structures causing endometritis, salpingitis, pelvic peritonitis or tubo-ovarian abscess. The cervicitis is not included in the list. The clinical syndrome is not related to pregnancy and surgery.

3. E P IDEMIOLOGY The incidence of pelvic infection is on the rise due to the rise in sexually transmitted diseases. The incidence varies from 1–2 percent per year among sexually active women.

4. E P IDEMIOLOGY 85% 15 % Following p r o ce du re s Spontaneous infection in sexually active females About 85% are spontaneous infection in sexually active females of reproductive age. The remaining 15% follow procedures (include endometrial biopsy, uterine curettage, insertion of IUD and hysterosalpingography.

5. RISK FACTORS Menstruating teenagers. Multiple sexual partners. Absence of contraceptive pill use. Previous history of acute PID. IUD users. Area with high prevalence of sexually transmitted diseases.

6. PROTECTIVE FACTORS Contraceptive practice Barrier methods , specially condom, diaphragm with spermicides. Oral steroidal contraceptives have got two preventive aspects. Produce thick mucus plug preventing ascent of sperm and bacterial penetration. Decrease in duration of menstruation, creates a shorter interval of bacterial colo- nization of the upper tract. Monogamy or having a partner who had vasectomy. Others Pregnancy Menopause Vaccines : hepatitis B, HPV

7. CLINICAL FEATURES Symptoms Patients with acute PID present with a wide range of non-specific clinical symptoms. Symptoms usually appear at the time and immediately after the menstruation. Bilateral lower abdominal and pelvic pain which is dull in nature. The onset of pain is more rapid and acute in gonococcal infection (3 days) than in chlamydial infection (5–7 days). There is fever , lassitude and headache . Irregular and excessive vaginal bleeding is usually due to associated endometritis. Abnormal vaginal discharge which becomes purulent and or copious.

8. CLINICAL FEATURES Symptoms Nausea and vomiting . Dyspareunia. Pain and discomfort in the right hypochondrium due to concomitant perihepatitis ( Fitz-Hugh-Curtis syndrome ) may occur in 5–10% of cases of acute salpingitis. The liver is involved due to transperitoneal or vascular dissemination of either gonococcal or chlamydial infection.

9. CLINICAL FEATURES Signs The temperature is elevated to beyond 38.3°C . Abdominal palpation reveals tenderness on both the quadrants of lower abdomen. The liver may be enlarged and tender . Vaginal examination reveals: Abnormal vaginal discharge which may be of purulent . Congested external urethral meatus or openings of Bartholin’s ducts through which pus may be seen escaping out on pressure. Speculum examination shows congested cervix with purulent discharge from the canal. Bimanual examination reveals bilateral tenderness on fornix palpation, which increases more with movement of the cervix. There may be thickening or a definite mass felt through the fornices.

10. CLINICAL FEATURES

11. CLINICAL DIAGNOSTIC CRITERIA OF PID ( CDC 2015) Minimum Criteria Adnexal tenderness. Cervical motion tenderness. Uterine tenderness Definitive Criteria Endometrial biopsy with histopathologic evidence of endometritis; Transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies suggesting pelvic infection (e.g., tubal hyperemia); Laparoscopic findings consistent with PID. Additional Criteria Oral temperature >101°F (>38.3°C); Abnormal cervical mucopurulent discharge or cervical friability; Presence of abundant numbers of WBC on saline microscopy of vaginal fluid; Elevated ESR; Elevated CRP; laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis.

12. TREATMENT To prevent reinfection. 3 To prevent infertility and late sequelae. 02 01 THE PRINCIPLES OF THERAPY

13. HOMOEOPATHIC APPROACH

14. HOMOEOPATHIC REMEDIES APIS MELLIFICA CALADIUM PLATINA SEPIA NATRUM MURIATICUM CALCAREA CARBONIA CANTHARIS PALLADIUM PULSATILLA HYDRASTIS BELLADONNA

15. APIS MELLIFICA

16. CALADIUM

17. PLATINA

18. SEPIA

19. NATRUM MURIATICUM

20. PREVENTION The following formalities are to be rigidly followed to prevent reinfection: Educating the patient to avoid reinfection and the potential hazards of it. The patient should be warned against multiple sexual partners. To use condom. The sexual partner or partners are to be traced and properly investigated to find out the organism(s) and treated effectively. If they have got non- gonococcal urethritis, they should be treated with tetracycline 500 mg 6 hourly or doxycycline 100 mg twice daily for 7 days.

21. Thank You