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Publication - Dr Valentine Akande

    Tubal pelvic damage

    prediction and prognosis

    Citation

    Akande, V, 2002, ‘Tubal pelvic damage: prediction and prognosis’. Human Fertility, vol 5., pp. S15-S20

    Abstract

    Tubal pelvic damage is a common cause of infertility, and laparoscopy
    is the accepted gold standard for its diagnosis. However, laparoscopy
    is both costly and invasive. Chlamydia is now recognized as the
    most common cause of tubal pelvic damage. In contrast to laparoscopy,
    evidence of past chlamydial infection using serology is readily
    avilable, and the test is simple and quick to perform. As such, serology
    can be used as a screening test in infertile women. It is accepted that
    screening tests may have higher margins of error and may be less
    accurate than diagnostic tests. Screening is most valuable when
    detecting a disease for which the treatment is more effective when
    undertaken at the earliest opportunity. Because there are justified
    constraints to the indiscriminate use of laparoscopy, there is a need to
    minimize the number of patients who do not have disease (false
    positives) who are subjected to this diagnostic investigation. An
    appropriate Chlamydia antibody titre that would distinguish women
    at risk of tubal pelvic damage should be determined using diagnostic
    test analysis and clinical judgement. Identification by serology of
    women who are likely to have damage would enable these women to undergo a
    diagnostic test such as laparoscopy sooner, allowing treatment to be
    provided earlier. However, the severity of tubal pelvic damage varies,
    and the need to distinguish women with a favourable or unfavourable
    prognosis after treatment using a simple classification system is
    discussed.

    Full details in the University publications repository