ABSTRACT Approximately 50 % of patients are less than 35 years of age at the time of diagnosis an... more ABSTRACT Approximately 50 % of patients are less than 35 years of age at the time of diagnosis and 25 % conceive for the first time after their diagnosis of inflammatory bowel disease (IBD) [1–3]. This age range corresponds to female reproductive age and increases the likelihood of Crohn’s disease (CD) during pregnancy.
Despite an increase in the number of effective broad-spectrum antibiotics, pelvic inflammatory di... more Despite an increase in the number of effective broad-spectrum antibiotics, pelvic inflammatory disease (PID) and the complications arising from the disease continue to reach epidemic proportions into the 1990s. Acute salpingitis and PID account for more than 350,000 hospital admissions and 150,000 surgical procedures per year [1]. In addition, some report that nearly one-third of patients hospitalized for PID develop some degree of pelvic abscess [2]. Other sequels such as ectopic pregnancy, salpingitis isthmica nodosa, tubal infertility, chronic pelvic pain syndromes, and pelvic adhesions are other consequences of PID. Tubo-ovarian abscess (TOA) is the most serious manifestation of salpingitis because the intra-abdominal rupture of a TOA is potentially life-threatening, with mortality rates as high as 8.6 % [3]. Pelvic inflammatory disease and subsequent TOA may result whenever bacteria gain access to the upper female genital tract. Under normal circumstances, the Fallopian tubes and related pelvic structures are sterile. However, access of bacteria into the upper genital tract either via sexually transmitted diseases or through instrumentation of the uterus may inoculate the uterus with bacteria from the vagina, causing infection. It has been suggested that passive transport and vectors such as spermatozoa and Trichomonas assist in establishing the ascending infection from the polymicrobial vagina and cervix [4]. Once present in the upper genital tract in sufficient numbers and virulence, these bacteria initiate an inflammatory reaction (endometritis-salpingitis-peritonitis) that results in the signs and symptoms of PID. The rate of a TOA developing from typical PID is in the range of 1–4 % [5].
Follicular and corpus luteum cysts of the ovary are functional cysts and benign growths of the ov... more Follicular and corpus luteum cysts of the ovary are functional cysts and benign growths of the ovary. A follicular cyst arises from a normal follicle that fails to undergo ovulation or does not undergo the normal atretic process. It is usually clear and fluid filled. Corpus luteum cysts are less common than follicular cysts but are more associated with clinical symptoms. Ovarian cysts are not commonly found in pregnancy. Eiss, in 1930, reports a case of bilateral tumors, each of which ruptured in pregnancy. Their frequency varies with reports of different series. In Sloane Hospital (1931), the incidence was 1/500 pregnancies; in the University of California Hospital, 1/1,500, and in McKerron’s compilations (1903), it was 1/2,500 pregnancies [1]. The tumors are thought to occur more often in nonpregnant women of the same relative age for which reason some believe they interfere with conception. Most of the cysts are small; they may or may not grow rapidly during pregnancy.
Complex ovarian mass is a separate entity from adnexal torsion which is only one presentation due... more Complex ovarian mass is a separate entity from adnexal torsion which is only one presentation due to ovarian mass and is described in detail in a separate chapter. Complex ovarian mass found in pregnancy is important for several reasons: (1) adnexal torsion, as a result, should be detorsed immediately to preserve ovarian function, (2) persistent pain, (3) ovarian mass rupture and bleeding, and (4) tumor with malignant potential. Persistent pain or compression of surrounding structures is important because it commonly does not subside without surgical intervention. The timing of the operation is critical because intervention during the second trimester carries the lowest risk of obstetric complications. Intra-abdominal bleeding is difficult to diagnose initially, especially if bleeding is small. Bleeding from ovarian mass is always the indication for immediate operation. The most difficult issue is asymptomatic and small ovarian mass. Small ovarian mass can commonly be treated conservatively if the malignancy is excluded. There are different imaging and non-imaging methods for confirmation of malignancy. Malignancy status determines the timing and the type of treatment intervention.
The specific issue with acute abdomen during pregnancy is that many underlying conditions result ... more The specific issue with acute abdomen during pregnancy is that many underlying conditions result in inflammation and infection which raise prostaglandin levels which are crucial for the normal progress of labor. Therefore, it is mandatory to stop the increased preterm production of prostaglandins. The only solution is early diagnosis and treatment of acute abdominal conditions during pregnancy. In addition to inflammation, abdominal trauma is also an issue. It can cause placental abruption and preterm labor. In addition to these two most common groups of the acute abdomen during pregnancy, other important topics are discussed. These include maternal and fetal stress as a result of any cause of acute abdomen during pregnancy and the problem of adequate perioperative nutrition. Inadequate maternal nutrition is present in some diseases with prolonged course before therapeutic interventions such as conservatively treated acute cholecystitis or acute pancreatitis. Prolonged inadequate postoperative nutrition is seen after many surgical procedures especially in those that require bowel resections or reoperations. Therefore, the underlying pathology should be diagnosed and treated early in the course of the disease, and additional measures for detection and prevention of preterm labor should be instituted as early as possible.
ABSTRACT Approximately 50 % of patients are less than 35 years of age at the time of diagnosis an... more ABSTRACT Approximately 50 % of patients are less than 35 years of age at the time of diagnosis and 25 % conceive for the first time after their diagnosis of inflammatory bowel disease (IBD) [1–3]. This age range corresponds to female reproductive age and increases the likelihood of Crohn’s disease (CD) during pregnancy.
Despite an increase in the number of effective broad-spectrum antibiotics, pelvic inflammatory di... more Despite an increase in the number of effective broad-spectrum antibiotics, pelvic inflammatory disease (PID) and the complications arising from the disease continue to reach epidemic proportions into the 1990s. Acute salpingitis and PID account for more than 350,000 hospital admissions and 150,000 surgical procedures per year [1]. In addition, some report that nearly one-third of patients hospitalized for PID develop some degree of pelvic abscess [2]. Other sequels such as ectopic pregnancy, salpingitis isthmica nodosa, tubal infertility, chronic pelvic pain syndromes, and pelvic adhesions are other consequences of PID. Tubo-ovarian abscess (TOA) is the most serious manifestation of salpingitis because the intra-abdominal rupture of a TOA is potentially life-threatening, with mortality rates as high as 8.6 % [3]. Pelvic inflammatory disease and subsequent TOA may result whenever bacteria gain access to the upper female genital tract. Under normal circumstances, the Fallopian tubes and related pelvic structures are sterile. However, access of bacteria into the upper genital tract either via sexually transmitted diseases or through instrumentation of the uterus may inoculate the uterus with bacteria from the vagina, causing infection. It has been suggested that passive transport and vectors such as spermatozoa and Trichomonas assist in establishing the ascending infection from the polymicrobial vagina and cervix [4]. Once present in the upper genital tract in sufficient numbers and virulence, these bacteria initiate an inflammatory reaction (endometritis-salpingitis-peritonitis) that results in the signs and symptoms of PID. The rate of a TOA developing from typical PID is in the range of 1–4 % [5].
Follicular and corpus luteum cysts of the ovary are functional cysts and benign growths of the ov... more Follicular and corpus luteum cysts of the ovary are functional cysts and benign growths of the ovary. A follicular cyst arises from a normal follicle that fails to undergo ovulation or does not undergo the normal atretic process. It is usually clear and fluid filled. Corpus luteum cysts are less common than follicular cysts but are more associated with clinical symptoms. Ovarian cysts are not commonly found in pregnancy. Eiss, in 1930, reports a case of bilateral tumors, each of which ruptured in pregnancy. Their frequency varies with reports of different series. In Sloane Hospital (1931), the incidence was 1/500 pregnancies; in the University of California Hospital, 1/1,500, and in McKerron’s compilations (1903), it was 1/2,500 pregnancies [1]. The tumors are thought to occur more often in nonpregnant women of the same relative age for which reason some believe they interfere with conception. Most of the cysts are small; they may or may not grow rapidly during pregnancy.
Complex ovarian mass is a separate entity from adnexal torsion which is only one presentation due... more Complex ovarian mass is a separate entity from adnexal torsion which is only one presentation due to ovarian mass and is described in detail in a separate chapter. Complex ovarian mass found in pregnancy is important for several reasons: (1) adnexal torsion, as a result, should be detorsed immediately to preserve ovarian function, (2) persistent pain, (3) ovarian mass rupture and bleeding, and (4) tumor with malignant potential. Persistent pain or compression of surrounding structures is important because it commonly does not subside without surgical intervention. The timing of the operation is critical because intervention during the second trimester carries the lowest risk of obstetric complications. Intra-abdominal bleeding is difficult to diagnose initially, especially if bleeding is small. Bleeding from ovarian mass is always the indication for immediate operation. The most difficult issue is asymptomatic and small ovarian mass. Small ovarian mass can commonly be treated conservatively if the malignancy is excluded. There are different imaging and non-imaging methods for confirmation of malignancy. Malignancy status determines the timing and the type of treatment intervention.
The specific issue with acute abdomen during pregnancy is that many underlying conditions result ... more The specific issue with acute abdomen during pregnancy is that many underlying conditions result in inflammation and infection which raise prostaglandin levels which are crucial for the normal progress of labor. Therefore, it is mandatory to stop the increased preterm production of prostaglandins. The only solution is early diagnosis and treatment of acute abdominal conditions during pregnancy. In addition to inflammation, abdominal trauma is also an issue. It can cause placental abruption and preterm labor. In addition to these two most common groups of the acute abdomen during pregnancy, other important topics are discussed. These include maternal and fetal stress as a result of any cause of acute abdomen during pregnancy and the problem of adequate perioperative nutrition. Inadequate maternal nutrition is present in some diseases with prolonged course before therapeutic interventions such as conservatively treated acute cholecystitis or acute pancreatitis. Prolonged inadequate postoperative nutrition is seen after many surgical procedures especially in those that require bowel resections or reoperations. Therefore, the underlying pathology should be diagnosed and treated early in the course of the disease, and additional measures for detection and prevention of preterm labor should be instituted as early as possible.
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