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Tubo-Ovarian Abscess Management Options for Women Who Desire Fertility

Rosen, Mitchell MD*; Breitkopf, Dan MD; Waud, Kay MD

Obstetrical & Gynecological Survey: October 2009 - Volume 64 - Issue 10 - p 681-689
doi: 10.1097/OGX.0b013e3181b8b0d6
CME Program: CATEGORY 1 CME REVIEW ARTICLES 28, 29, AND 30: CME REVIEW ARTICLE 29
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CME

Tubo-ovarian abscess (TOA), a serious sequela of pelvic inflammatory disease, occurs usually in women of ages 20 to 40. Up to 59% of these women are nulliparous. Traditionally, pregnancy rates after TOA are estimated to be 15% or less. Current proposed management algorithms for TOA do not include a separate pathway for women of reproductive age who may desire future pregnancies.

A MEDLINE search and extensive review of published literature was undertaken to study management options for patients with TOA, and to compare rates of responders, pregnancies and complications associated with each management option. If intra-abdominal rupture is suspected, and patients are treated with fertility-preserving, conservative surgery, reported pregnancy rate is 25%. If no rupture is suspected and patients are treated with medical management alone, reported pregnancy rates vary between 4% and 15%. If no rupture is suspected, and the treatment is medical management with immediate laparoscopic drainage within 24 hours, reported pregnancy rates vary between 32% and 63%.

Laparoscopy should be considered to all patients with TOA who desire future conception. Overall, the advantages of immediate laparoscopy allow for an accurate diagnosis, effective treatment under magnification with minimal complications, possibly faster response rates with shorter hospitalization times and decreased infertility.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this educational activity, the participant should be better able to create an active management plan for patients presenting with acute tubo-ovarian abscess, identify cases of women with pelvic inflammatory disease and tubo-ovarian abscess with increased frequency, and describe outcomes of various management strategies for women with tubo-ovarian abscess.

*Assistant Adjunct Professor, Department of Reproductive Endocrinology and Infertility, University of California, San Francisco, CA; †Assistant Professor, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX; and ‡Medical Student, School of Medicine, University of California, San Diego, CA

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprint requests to: Mitchell Rosen, MD, UCSF Center for Reproductive Health, 2356 Sutter Street, 7th Floor, San Francisco, CA 94115. E-mail: rosenm@obgyn.ucsf.edu.

© 2009 Lippincott Williams & Wilkins, Inc.