Tubal Diseases
Inflammatory process of the pelvis, or pelvic inflammatory disease (PID), is a frequent and serious yet treatable disease that can lead to abscess formation or pelvic fluid accumulation. When the abscess or the fluid remains into the tube, the pathology w
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Tubal Diseases Stefano Guerriero, Silvia Ajossa, Valentina Corda, Maura Perniciano, Alba Piras, and Alessandra Cappai
3.1
Background
3.1.1
Definition
Inflammatory process of the pelvis, or pelvic inflammatory disease (PID), is a frequent and serious yet treatable disease that can lead to abscess formation or pelvic fluid accumulation. When the abscess or the fluid remains into the tube, the pathology was called hydrosalpinx or pyosalpinx [1]. The condition can affect one or both fallopian tubes.
3.1.2
Epidemiology
It has been estimated that, in the USA, approximately 10–15 % of women in their reproductive years have had at least one episode of inflammatory disease of tubes and that at least 30 % of infertility problems and 50 % of ectopic pregnancies can be attributed to a previous episode of PID [2, 3]. The main agents responsible for the disease are Neisseria gonorrhoeae and Chlamydia. Hydrosalpinx is reported in the 2–3 % [4, 5] of cases of adnexal masses submitted to surgery. Electronic supplementary material The online version of this chapter (doi:10.1007/978-3319-41037-1_3) contains supplementary material, which is available to authorized users. S. Guerriero (*) • M. Perniciano • A. Piras • A. Cappai Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy e-mail: [email protected] S. Ajossa • V. Corda Department of Obstetrics and Gynecology, University of Cagliari, University Hospital Duilio Casula, Monserrato, Cagliari, Italy e-mail: [email protected] © Springer International Publishing Switzerland 2017 S. Guerriero et al. (eds.), Managing Ultrasonography in Human Reproduction, DOI 10.1007/978-3-319-41037-1_3
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3.1.3
S. Guerriero et al.
Symptomatology
Symptoms of acute tubal pathology are usually fever, purulent vaginal discharge, pelvic and abdominal tenderness, and laboratory findings of an inflammatory process. Clinical diagnosis of chronic hydrosalpinx, instead, is hampered by the lack of specificity of signs and symptoms. Usually, there are few symptoms noticed by patients although some women may suffer from abdominal or pelvic pain [1].
3.1.4
Hydrosalpinx and Infertility
Fallopian tube blockage is one of the factors of female infertility, and hydrosalpinx represents one of the causes of this pathology. In vitro fertilization (IVF) was originally developed to overcome the impediment created by tubal obstruction. However, the success of in vitro fertilization is significantly lower for women with hydrosalpinx compared to other causes of infertility, and bilateral hydrosalpinx yields about one-half of the rate of implantation of the unilateral form [6–9].
3.1.5
Therapy
Several surgical approaches have been discussed to improve the chances of a fullterm pregnancy in patients with hydrosalpinges undergoing IVF. It was observed that implantation rates were improved after surgical treatment and had significantly better outcomes after salpingectomy [10]. Vaginal ultrasound-guided aspirat
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