The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
Roberta B Ness - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology, pathogenesis and treatment of pelvic Inflammatory Disease
Expert review of anti-infective therapy, 2006Co-Authors: Catherine L. Haggerty, Roberta B NessAbstract:Pelvic Inflammatory Disease, the infection and inflammation of the female upper genital tract, is a common cause of infertility, chronic pain and ectopic pregnancy. Diagnosis and management are challenging, due largely to a polymicrobial etiology which is not fully delineated. Signs and symptoms of this syndrome vary widely, further complicating diagnosis and treatment. Due to the potential for serious sequelae, a low threshold for diagnosis and treatment is recommended. Since pelvic Inflammatory Disease has a multimicrobial etiology including Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic and mycoplasmal bacteria, treatment of pelvic Inflammatory Disease should be broad spectrum. Recent treatment trials have focused on shorter duration regimens such as azithromycin and monotherapies including ofloxacin, although data are sparse. Research comparing sequelae development by differing antimicrobial regimens is extremely limited, but will ultimately shape future treatment guidelines. Several promising short-duration and monotherapy antibiotic regimens should be evaluated in pelvic Inflammatory Disease treatment trials for compliance, microbiological and clinical cure, and reduction of subsequent adverse reproductive and gynecological morbidity.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, Davison E. Soper, Giuliana TruccoAbstract:OBJECTIVE: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, David E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment. (Am J Obstet Gynecol 2002;186:929-37.)
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clinical predictors of endometritis in women with symptoms and signs of pelvic Inflammatory Disease
American Journal of Obstetrics and Gynecology, 2001Co-Authors: Jeffrey F. Peipert, Robert L Holley, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Richard L. Sweet, Roberta B Ness, David E. Soper, Jeffrey D Blume, Antonio J AmorteguiAbstract:Abstract Objective: Careful detection and treatment of pelvic Inflammatory Disease are essential for the prevention of adverse sequelae. The purpose of this study was to evaluate the diagnostic test characteristics of clinical criteria for the diagnosis of pelvic Inflammatory Disease. Study Design: We performed a cross-sectional analysis of the baseline characteristics of 651 patients enrolled in a multicenter randomized treatment trial for pelvic Inflammatory Disease. Clinical and laboratory findings were recorded for all patients, and endometrial sampling was performed. We calculated sensitivity and specificity and performed receiver operating characteristic curve analysis and multivariate logistic regression, using histologic endometritis as the criterion standard. Results: The minimal criteria for pelvic Inflammatory Disease, as recommended by the Centers for Disease Control and Prevention, had a sensitivity of 83%, in comparison with a 95% sensitivity for adnexal tenderness ( P =.001). Of the supportive clinical criteria, the finding most highly associated with endometritis was a positive test result for Chlamydia trachomatis or Neisseria gonorrhoeae (adjusted odds ratio, 4.3; 95% confidence interval, 2.89-6.63). A multivariate logistic regression model indicated that combinations of criteria significantly improve the prediction of endometritis. Conclusion: Sensitivity can be maximized by using the presence of adnexal tenderness as a minimal criterion for the diagnosis of pelvic Inflammatory Disease, and supportive criteria are helpful in estimating the probability of endometritis. (Am J Obstet Gynecol 2001;184:856-64.)
Giuliana Trucco - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, Davison E. Soper, Giuliana TruccoAbstract:OBJECTIVE: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, David E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment. (Am J Obstet Gynecol 2002;186:929-37.)
Antonio J Amortegui - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, Davison E. Soper, Giuliana TruccoAbstract:OBJECTIVE: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, David E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment. (Am J Obstet Gynecol 2002;186:929-37.)
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clinical predictors of endometritis in women with symptoms and signs of pelvic Inflammatory Disease
American Journal of Obstetrics and Gynecology, 2001Co-Authors: Jeffrey F. Peipert, Robert L Holley, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Richard L. Sweet, Roberta B Ness, David E. Soper, Jeffrey D Blume, Antonio J AmorteguiAbstract:Abstract Objective: Careful detection and treatment of pelvic Inflammatory Disease are essential for the prevention of adverse sequelae. The purpose of this study was to evaluate the diagnostic test characteristics of clinical criteria for the diagnosis of pelvic Inflammatory Disease. Study Design: We performed a cross-sectional analysis of the baseline characteristics of 651 patients enrolled in a multicenter randomized treatment trial for pelvic Inflammatory Disease. Clinical and laboratory findings were recorded for all patients, and endometrial sampling was performed. We calculated sensitivity and specificity and performed receiver operating characteristic curve analysis and multivariate logistic regression, using histologic endometritis as the criterion standard. Results: The minimal criteria for pelvic Inflammatory Disease, as recommended by the Centers for Disease Control and Prevention, had a sensitivity of 83%, in comparison with a 95% sensitivity for adnexal tenderness ( P =.001). Of the supportive clinical criteria, the finding most highly associated with endometritis was a positive test result for Chlamydia trachomatis or Neisseria gonorrhoeae (adjusted odds ratio, 4.3; 95% confidence interval, 2.89-6.63). A multivariate logistic regression model indicated that combinations of criteria significantly improve the prediction of endometritis. Conclusion: Sensitivity can be maximized by using the presence of adnexal tenderness as a minimal criterion for the diagnosis of pelvic Inflammatory Disease, and supportive criteria are helpful in estimating the probability of endometritis. (Am J Obstet Gynecol 2001;184:856-64.)
David E. Soper - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, David E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment. (Am J Obstet Gynecol 2002;186:929-37.)
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clinical predictors of endometritis in women with symptoms and signs of pelvic Inflammatory Disease
American Journal of Obstetrics and Gynecology, 2001Co-Authors: Jeffrey F. Peipert, Robert L Holley, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Richard L. Sweet, Roberta B Ness, David E. Soper, Jeffrey D Blume, Antonio J AmorteguiAbstract:Abstract Objective: Careful detection and treatment of pelvic Inflammatory Disease are essential for the prevention of adverse sequelae. The purpose of this study was to evaluate the diagnostic test characteristics of clinical criteria for the diagnosis of pelvic Inflammatory Disease. Study Design: We performed a cross-sectional analysis of the baseline characteristics of 651 patients enrolled in a multicenter randomized treatment trial for pelvic Inflammatory Disease. Clinical and laboratory findings were recorded for all patients, and endometrial sampling was performed. We calculated sensitivity and specificity and performed receiver operating characteristic curve analysis and multivariate logistic regression, using histologic endometritis as the criterion standard. Results: The minimal criteria for pelvic Inflammatory Disease, as recommended by the Centers for Disease Control and Prevention, had a sensitivity of 83%, in comparison with a 95% sensitivity for adnexal tenderness ( P =.001). Of the supportive clinical criteria, the finding most highly associated with endometritis was a positive test result for Chlamydia trachomatis or Neisseria gonorrhoeae (adjusted odds ratio, 4.3; 95% confidence interval, 2.89-6.63). A multivariate logistic regression model indicated that combinations of criteria significantly improve the prediction of endometritis. Conclusion: Sensitivity can be maximized by using the presence of adnexal tenderness as a minimal criterion for the diagnosis of pelvic Inflammatory Disease, and supportive criteria are helpful in estimating the probability of endometritis. (Am J Obstet Gynecol 2001;184:856-64.)
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Pelvic Inflammatory Disease in the postmenopausal woman.
Infectious diseases in obstetrics and gynecology, 1999Co-Authors: S.l. Jackson, David E. SoperAbstract:Objective: Review available literature on pelvic Inflammatory Disease in postmenopausal women. Design: MEDLINE literature review from 1966 to 1999. Results: Pelvic Inflammatory Disease is uncommon in postmenopausal women. It is polymicrobial, often is concurrent with tuboovarian abscess formation, and is often associated with other diagnoses. Conclusion: Postmenopausal women with pelvic Inflammatory Disease are best treated with inpatient parenteral antimicrobials and appropriate imaging studies. Failure to respond to antibiotics should yield a low threshold for surgery, and consideration of alternative diagnoses should be entertained. Infect. Dis. Obstet. Gynecol. 7:248-252, 1999. (C) 1999Wiley-Liss, Inc.
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Surgical considerations in the diagnosis and treatment of pelvic Inflammatory Disease.
The Surgical clinics of North America, 1991Co-Authors: David E. SoperAbstract:Pelvic Inflammatory Disease continues to be a significant cause of morbidity in the reproductive-aged woman. Although most cases are caused by sexually transmitted pathogens, a significant number are associated with a polymicrobial flora. Evaluation of the patient’s vaginal secretions for evidence of infection can help differentiate pelvic Inflammatory Disease from acute appendicitis. Diagnostic laparoscopy is helpful in dealing with the low specificity of the clinical diagnosis of pelvic Inflammatory Disease. Although antibiotics are the mainstay of treatment, surgery is useful in some cases.
Richard L. Sweet - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, Davison E. Soper, Giuliana TruccoAbstract:OBJECTIVE: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. RESULTS: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment.
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effectiveness of inpatient and outpatient treatment strategies for women with pelvic Inflammatory Disease results from the pelvic Inflammatory Disease evaluation and clinical health peach randomized trial
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Roberta B Ness, Robert L Holley, Jeffrey Peipert, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Antonio J Amortegui, Richard L. Sweet, David E. Soper, Giuliana TruccoAbstract:Abstract Objective: Pelvic Inflammatory Disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic Inflammatory Disease are treated as outpatients, the effectiveness of this strategy remains unproven. Study Design: We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic Inflammatory Disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic Inflammatory Disease, chronic pelvic pain, and ectopic pregnancy. Results: Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic Inflammatory Disease recurrence, chronic pelvic pain, or ectopic pregnancy. Conclusion: Among women with mild-to-moderate pelvic Inflammatory Disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment. (Am J Obstet Gynecol 2002;186:929-37.)
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clinical predictors of endometritis in women with symptoms and signs of pelvic Inflammatory Disease
American Journal of Obstetrics and Gynecology, 2001Co-Authors: Jeffrey F. Peipert, Robert L Holley, Hugh Randall, Steven J Sondheimer, Susan L Hendrix, Richard L. Sweet, Roberta B Ness, David E. Soper, Jeffrey D Blume, Antonio J AmorteguiAbstract:Abstract Objective: Careful detection and treatment of pelvic Inflammatory Disease are essential for the prevention of adverse sequelae. The purpose of this study was to evaluate the diagnostic test characteristics of clinical criteria for the diagnosis of pelvic Inflammatory Disease. Study Design: We performed a cross-sectional analysis of the baseline characteristics of 651 patients enrolled in a multicenter randomized treatment trial for pelvic Inflammatory Disease. Clinical and laboratory findings were recorded for all patients, and endometrial sampling was performed. We calculated sensitivity and specificity and performed receiver operating characteristic curve analysis and multivariate logistic regression, using histologic endometritis as the criterion standard. Results: The minimal criteria for pelvic Inflammatory Disease, as recommended by the Centers for Disease Control and Prevention, had a sensitivity of 83%, in comparison with a 95% sensitivity for adnexal tenderness ( P =.001). Of the supportive clinical criteria, the finding most highly associated with endometritis was a positive test result for Chlamydia trachomatis or Neisseria gonorrhoeae (adjusted odds ratio, 4.3; 95% confidence interval, 2.89-6.63). A multivariate logistic regression model indicated that combinations of criteria significantly improve the prediction of endometritis. Conclusion: Sensitivity can be maximized by using the presence of adnexal tenderness as a minimal criterion for the diagnosis of pelvic Inflammatory Disease, and supportive criteria are helpful in estimating the probability of endometritis. (Am J Obstet Gynecol 2001;184:856-64.)