Standardised management of PID in a developing country.

During a 15 month period, 464 patients admitted to hospital with pelvic inflammatory disease (PID) were classified according to Monif's staging and treated following strict guidelines. Stage II, PID with peritoneal reaction, was treated with intravenous antibiotics. Stage III, PID with tubo-ovarian mass, was drained by posterior colpotomy when indicated or treated with triple antibiotics when high abdominal masses were present. Stage IV, ruptured tubo-ovarian abscess, was always surgically treated. Mortality was almost limited to patients with stage IV PID, 15% (3/20) of whom died. Morbidity included the need for laparotomy (in 1.6% (6/368) of stage II, 59.3% (45/76) of stage III, and 100% of 20 stage IV patients) and draining pus (in 6.6% (5/76) of stage III cases and 50% (10/20) of stage IV patients). This study also shows that unspecialised hospital staff are able to use Monif's staging correctly, and that acceptable results can be obtained with the limited resources that are available in most developing countries.