PELVIC INFLAMMATORY DISEASE ( PID ) : A CROSS SECTIONAL PROSPECTIVE STUDY AT A TERTIARY CARE CENTRE

Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis [ ]. The incidence of acute PID has decreased in many countries, though its true prevalence is not well known because most of cases are subclinical [3,4]. According to previous studies, its incidence varies between 0.28% and 1.67% worldwide [5,6]. PID affects predominately in the reproductive age years with its highest prevalence being in the second and third decades [7].


INTRODUCTION
Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis [ 1,2 ]. The incidence of acute PID has decreased in many countries, though its true prevalence is not well known because most of cases are subclinical [3,4]. According to previous studies, its incidence varies between 0.28% and 1.67% worldwide [5,6]. PID affects predominately in the reproductive age years with its highest prevalence being in the second and third decades [7].
The inflammation observed in PID results from infection, mostly bacterial [3]. The micro-organisms responsible can be Chlamydia trachomatis, Neisseria gonorrhea, Streptococcus sp, Enterococcus faecalis, Esche-the clinical profile of PID in a tertiary care centre. Exclusion criteria: Women of child bearing age with established other causes of lower abdominal pain, pregnant women, before menarche and postmenopausal women were excluded. Methodology: History & examination was conducted in details as per prescribed proforma. All the parameters like age, parity, socioeconomic status, age of marriage, sexual behavior, Presenting complaints and use of contraceptive were recorded.

MATERIALS AND METHODS
Statistical analysis: Data were analyzed in tabular form & in percentage. Findings from this study were compared with similar other studies.

Table 3. Distribution of cases according to education
Incidence of PID was commonest amongst illiterate women (36%), followed by women having education up to primary level (28%).

Table 4. Distribution of cases according to socioeconomic class
Maximum number of cases was seen in women from lower socioeconomic class (74%).In higher socioeconomic class only 6.5% cases were seen.

Table 9. Per Abdomen Examination findings
Abdominal tenderness was seen in 95 % of cases. Palpable mass was present in 11 % of cases.

DISCUSSION
PID is one of the common clinical complaints in gynecologic practice. PID implies inflammation of the upper genital tract involving fallopian tube as well as ovaries because most of PID is due to ascending or blood borne infection, the lesion is often bilateral though one tube may be affected than the other.
In our study most common age group was 20-24 years (29.5%), followed by 25-29 years (26.5%). Least common age group was <20 years (2%).These findings are similar to study conducted by Elie Nkwabong et al [16] which also shows maximum age incidence in 20-24 years age group (27.2%), followed by 25-29 years (24.3%). PID affects predominately in the reproductive age years with its highest prevalence being in the second and third decades [7].
Maximum number of cases in this study was seen in parity between 2-5 (58%).Incidence was minimum in nullipara (5%).These findings are consistent with study by S Ahmed et al [17] who have documented maximum incidence of cases in parity between 2-5 (56%).
In this study incidence of PID was commonest amongst illiterate women (36%), followed by women having education up to primary level (28%). If we compare this study with study by Elie Nkwabong et al [16] where maximum incidence of PID in women having education below SSC (54.3%) followed by education below primary education (20%).
In our study maximum number of cases was seen in women from lower socioeconomic class (74%). In higher socioeconomic class only 6.5% cases were seen. These findings are comparable with that of S Ahmed et al [17], where 60% & 36% cases were from low & middle class respectively & only 4 % cases belonged to higher class. This supports the fact that PID is common amongst women from lower socioeconomic class.
Out of 200 cases in our study, 79% patients were married, 14 % were remarried. Incidence was lowest in unmarried group (1%).These findings are somewhat comparable with study by S Ahmed et al [17], where married patients contribute to 90% of cases ;but different from study by Elie Nkwabong et al [16] who found out incidence in married patients somewhat lower (41%). Marital status is often referred to as risk marker for PID because active sexual life has an impact on the occurrence of PID [18].
In our study 51 % cases did not use any contraception. IUCD users were 26%.14 % underwent tubectomy. These findings are comparable with study by Patel Sangeeta etal [19] who found out 19.33 % cases using IUCD as a contraceptive agent. During IUCD insertion, there is introduction of vaginal and cervical organisms into the endometrial cavity and accounts for most cases of IUCD related PID [17].

CONCLUSION
Present study shows that incidence of pelvic inflammatory disease is higher in age group between 20-29 years, multipara, women from lower socioeconomic class & illiterate women. Pain in lower abdomen, per vaginal discharge & fever are the commonest complaints. Most of the patients on examination had forniceal & cervical motion tenderness.