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  • Title: Acute pelvic infection following hysterosalpingography at the Kenyatta National Hospital, Nairobi.
    Author: Lema VM, Majinge CR.
    Journal: East Afr Med J; 1993 Sep; 70(9):551-5. PubMed ID: 8181434.
    Abstract:
    A total of 150 women who had hysterosalpingography (HSG) for investigation of infertility, at the Kenyatta National Hospital over a five month period, were recruited into the study to determine the prevalence of pelvic infection following the procedure. 44.0% of the total study group developed pelvic infection disease (PID) within the first week after the procedure. There were no obvious determining factors. It is possible that most women with infertility have quiescent genital tract infection, prior to HSG, with the latter only facilitating the entry of micro-organisms into the upper genital tract, thus causing pelvic infection or reactivating a pre-existing infections. Further studies should be conducted to determine the microbial patterns of the infection. There should be routine provision of prophylactic antimicrobial agent(s) to all women undergoing HSG in our unit to minimise the risk of developing pelvic infection and further damage to the uterine tubes which will worsen the prognosis. Between September 1988 and January 1989 in Kenya, health care providers recruited 150 infertile women, 15-39 years old, who had gone to a gynecological outpatient clinic at Kenyatta National Hospital in Nairobi to undergo hysterosalpingography to determine the condition of the uterus and fallopian tubes. The aim of the study was to determine whether there was an association between hysterosalpingography and pelvic inflammatory disease (PID) and the determinants for PID. Most women were between 20-29 years old, married, and had a primary education (67.3%, 90.7%, and 55.3%, respectively). One week after hysterosalpingography, 44% developed acute PID, defined as having at least 2 of the following signs or symptoms: lower abdominal pain, rebound tenderness, cervical/adnexal tenderness, foul smelling vaginal discharge, adnexal mass(es), and fever of at least 38 degrees Celsius. The most frequent signs and symptoms were lower abdominal pain and tenderness. Married women were more likely to have PID than unmarried women (47.1% vs. 14.3%). The small numbers of unmarried women made it difficult to determine the significance of the difference, however. Sexual intercourse within the 1st week after hysterosalpingography was not associated with PID (45.2% for PID cases vs. 42.1% for non-PID cases). The researchers believed that hysterosalpingography pushed existing pathogens in the vagina into the uterus, or the women already had asymptomatic PID. They recommended further studies to determine whether physicians should administer prophylactic antibiotic therapy to all women undergoing hysterosalpingography.
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