Lis Maternity Hospital, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
J Minim Invasive Gynecol. 2019 Jan;26(1):162-168. doi: 10.1016/j.jmig.2018.06.004. Epub 2018 Jun 8.
To assess the clinical course and surgical and fertility outcomes of patients diagnosed with tubo-ovarian abscess (TOA) after fertility treatment.
Parallel case series over 10 consecutive years (Canadian Task Force classification II-2).
Tel Aviv Sourasky Medical Center, a tertiary university-affiliated hospital.
Thirty-seven women who were diagnosed with TOA after fertility treatments (in vitro fertilization and intrauterine insemination) were compared with 313 women who were diagnosed with TOA not associated with fertility treatments during the same time period.
Medical records search, chart review, and phone survey were used to assess clinical course and surgical and reproductive outcomes.
Women with TOA after fertility treatments had significantly higher inflammatory markers upon admission compared with the nonfertility treatment group (mean white blood cell count, 16.1 × 1000/mm [standard deviation [SD], ±4.3] vs 13.8 × 1000/mm [SD, ±6.3], p = .001, respectively; and mean C-reactive protein, 149 mg/L [SD, ±78.3] vs 78.2 mg/L [SD, ±68.5], p = .001, respectively). In addition, TOA after fertility treatments was associated with a significantly higher surgical intervention rate and a more complicated clinical course, as evidenced by a shorter time interval from admission to surgery (2.1 days vs 3.2 days, p = .01), higher rates of antibiotic failure, higher conversion rate from laparoscopy to laparotomy (14.2% vs 3.2%, p = .005), increased perioperative complications rate (25.0% vs 3.8%, p = .0001), and a longer hospitalization stay (7.2 days vs 4.8 days, p = .01). Clinical pregnancy rate per cycle in women with TOA after fertility treatments was 9%, and 1 case of live birth was recorded.
Our data indicate that TOA after fertility treatment has a substantial effect on the clinical course and surgical outcome. Prophylactic antibiotic treatment before ovum retrieval and deferral of embryo transfer should be considered in patients at risk of infection.
评估在接受生育治疗后被诊断为输卵管卵巢脓肿（TOA）的患者的临床病程以及手术和生育结局。
10 年来连续进行的平行病例系列研究（加拿大任务组分类 II-2）。
特拉维夫索拉斯基医学中心，一所三级大学附属医院。
37 名在生育治疗（体外受精和宫腔内人工授精）后被诊断为 TOA 的女性与同一时期内 313 名未接受生育治疗而被诊断为 TOA 的女性进行比较。
使用病历检索、图表审查和电话调查来评估临床病程以及手术和生殖结局。
与非生育治疗组相比，接受生育治疗后发生 TOA 的女性入院时炎症标志物显著升高（平均白细胞计数为 16.1×1000/mm[标准差（SD），±4.3]与 13.8×1000/mm[SD，±6.3]，p=0.001）；和平均 C 反应蛋白为 149mg/L[SD，±78.3]与 78.2mg/L[SD，±68.5]，p=0.001）。此外，生育治疗后发生 TOA 与更高的手术干预率和更复杂的临床病程相关，表现为从入院到手术的时间间隔更短（2.1 天与 3.2 天，p=0.01）、抗生素治疗失败率更高、腹腔镜到剖腹手术的转化率更高（14.2%与 3.2%，p=0.005）、围手术期并发症发生率增加（25.0%与 3.8%，p=0.0001）和住院时间延长（7.2 天与 4.8 天，p=0.01）。接受生育治疗后发生 TOA 的女性每个周期的临床妊娠率为 9%，记录到 1 例活产。
我们的数据表明，生育治疗后发生的 TOA 对临床病程和手术结局有重大影响。在有感染风险的患者中，应考虑在取卵前预防性使用抗生素治疗，并推迟胚胎移植。
