Treatment for Ectopic Pregnancy

Day 1 through Day 7

Day 1: Methotrexate 50 mg/m2 given IM

Day 4: Check BhCG

Day 7: Check BhCG

--> If hCG fails to decreas > 15% give second dose of methotrexate If not successful --> Surg

Etiology of PID

With and without IUD

and

S/S

S/S--> Cervical Motion tenderness, Adnexal  Tenderness

Lower abd tenderness, Mucopurulent Vag D/C, Fever>101F

With IUD: Actinomyces

W/out IUD: G&C

PEACH Trial

(Pelvic Inflammatory Disease Evaluation and Clinical Health)

Criteria used to increase speceficity of Dx

Temp>101F

Mucopurulent Vag D/C

abundant WBC on microscopy of vaginal secretions

ESR--> Eleveated

CRP--> Elevated

Lab documentation of G&C infx

Treatment of PID

1. Oral

Levofloxacin 500 mg PO dailyX14d

or

Ofloxacin 400mg PO Daily X14d

with or without

Metronidazole 500 mg PO Daily X14d

Treatment of PID

2. Single IM dose plus oral dosing

Rocephin 250 mg IMX1

plus

Doxy 100mg orally BIDX14days

with or without

Metronidazole 500 mg po BIDX 14d

or

Cefoxitin 2gm IM and Probenocid 1g POX1

plus

Doxy with or without metronidazole

1.Pregnant

2.Surg emergency cant be excluded

3. No response to oral tx ( 72 hours pt should be better)

4.Pt unable to follow an outpatient tx

5. Pt has sever N/V/Fever

6. Tubo-ovarian abscess

72 hours Pt should be better

Screen for C trichamatas and N gonorrhea  4-6 days p Tx

All wome with PID  should be offered HIV testing

Cefoxitin 2gm IV q6h

or

Cefotan 2gm IV q6h

plus

Doxy 100mg po/IV q12h

Tx D/C 24h p clinical improvement then:

Doxy 100mg PO BIDX14d and Clinda 450mg POBID14d

Levonorgestrel IUD

Copper Containing IUD

Infx occurs usually in first three weeks

No  data suggests removing IUD  once infx occurs

Endometriosis

Define

&

S/S

Presence of functioning Endometrial glands and stroma outside their usual location within the uterine cavity

Pain begins 2-7 days before menses and increases in intensity during menses

Risk Factors-->White Women

Treatment of  Endometriosis

Pain

GnRh Agonist--> temporary medical castration producing regression of endometriosis

Danazol-->adrenergic derivative (pseudomenopause)

Oral Contraceptives

Oral Progesterone

Levonogestrol IUD