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Peri-implantation pelvic inflammatory disease with normal pregnancy outcome.

Liberty G, Hyman JH, Margalioth EJ

Department of Obstetrics and Gynecology, Shaare Zedek Medical Center (affiliated with the Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheba), Jerusalem, Israel. liberg@013.net.il

OBJECTIVE: To report on the presentation, diagnostic assessment, treatment, and outcome of a case of peri-implantation pelvic inflammatory disease. DESIGN: Case report. SETTING: Emergency department and gynecology ward of a tertiary university hospital. PATIENT(S): A 25-year-old multiparous woman in her 1st month of pregnancy. INTERVENTION(S): Diagnostic laparoscopy, antibiotic therapy, and pregnancy surveillance. MAIN OUTCOME MEASURE(S): Surveillance and outcome of pregnancy. RESULT(S): The patient presented with abdominal pain and fever 26 days after her last menstrual period. Examination revealed peritoneal irritation and cervical tenderness, with free fluid in the pelvis. Diagnostic laparoscopy was performed, with no evidence of ectopic pregnancy. A significant quantity of yellow purulent fluid was drained from the pelvis, which cultured for Escherichia coli. Antibiotic therapy yielded excellent response. The pregnancy continued, with no complications, to healthy term delivery. CONCLUSION(S): This rare diagnosis of peri-implantation pelvic inflammatory disease should be considered in the differential diagnosis of abdominal pain in early pregnancy. Timely, rational treatment, including early pelvic drainage and appropriate antibiotic therapy, may save the pregnancy.

Published 8 October 2007 in Fertil Steril, 88(4): 969.e1-2.
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