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Standardised management of PID in a developing country
1Gweru Provincial Hospital, Zimbabwe.
Insights
Monif
Area of Science:
- Gynecology
- Infectious Diseases
- Surgical Management
Background:
- Pelvic inflammatory disease (PID) requires effective staging for appropriate treatment.
- Monif's staging provides a framework for classifying PID severity.
- Limited resources in developing countries necessitate adaptable treatment protocols.
Purpose of the Study:
- To evaluate the efficacy of Monif's staging in guiding PID treatment.
- To assess treatment outcomes and morbidity associated with different PID stages.
- To determine the feasibility of using Monif's staging in resource-limited settings.
Main Methods:
- A 15-month prospective study of 464 hospitalized PID patients.
- Classification of patients according to Monif's staging (Stages II, III, and IV).
- Treatment adherence to strict guidelines based on PID stage, including antibiotics, drainage, and surgery.
Main Results:
- Mortality was primarily observed in Stage IV (ruptured tubo-ovarian abscess), with a 15% death rate.
- Morbidity, including laparotomy and pus drainage, varied significantly by stage.
- Unspecialized staff accurately applied Monif's staging, achieving acceptable results.
Conclusions:
- Monif's staging is a practical tool for managing pelvic inflammatory disease, even with limited resources.
- Tailored treatment based on PID stage improves patient outcomes.
- The study demonstrates successful PID management in developing countries using established staging.
Abstract:
During a 15 month period, 464 patients admitted to hospital with pelvic inflammatory disease (PID) were classified according to Monif's staging and treated following strict guidelines. Stage II, PID with peritoneal reaction, was treated with intravenous antibiotics. Stage III, PID with tubo-ovarian mass, was drained by posterior colpotomy when indicated or treated with triple antibiotics when high abdominal masses were present. Stage IV, ruptured tubo-ovarian abscess, was always surgically treated. Mortality was almost limited to patients with stage IV PID, 15% (3/20) of whom died. Morbidity included the need for laparotomy (in 1.6% (6/368) of stage II, 59.3% (45/76) of stage III, and 100% of 20 stage IV patients) and draining pus (in 6.6% (5/76) of stage III cases and 50% (10/20) of stage IV patients). This study also shows that unspecialised hospital staff are able to use Monif's staging correctly, and that acceptable results can be obtained with the limited resources that are available in most developing countries.