Seth Granberg is something of a legend in the world of gynaecological ultrasound. He dreamt up looking at the thickness of the lining of the uterus to predict cancer, developed morphological scoring for ovarian masses and published on many other subjects in the field. I first met Seth in about 1990 at a conference in San Antonio – and have since worked with him, lived in his house when I worked in Sweden and he was a guess at my wedding. So I was delighted to see him publish again.
Seth and his colleague Knut Gjelland have written about fertility after drainage of a pelvic abscess under ultrasound guidance. They have shown in a series of 100 cases – that for the women who wanted to become pregnant – the fertility rate was 53%.
Probably in most units the standard approach to a tubo-ovarian abscess is a laparoscopy (surgery under an anaesthetic) and treatment with intravenous antibiotics. Seth and Knut have shown that ultrasound guided aspiration is a viable alternative with comparable fertility rates to when laparoscopy is carried out.
In the paper the authors set out their view of how to manage an abscess. The advise early intervention in the form of transvaginal drainage under ultrasound guidance accompanied by intravenous antibiotics until the patients temperature has come down for 24 hours. Two weeks of oral antibiotics are then prescribed and in general the patient discharged from hospital within 3 days.
Currently prior to surgery most units will try and see if there is a response to 48 hours of intravenous antibiotics. Seth and Knut are suggesting this leads to an unnecessary delay and that drainage first is a better option.