Pilot Study Evaluating Outpatient Management of Tubo-ovarian Abscesses

NCT ID: NCT05408624

Last Updated: 2024-03-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

60 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-07-15

Study Completion Date

2024-12-01

Brief Summary

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Pelvic inflammatory diseases (PID) require antibiotic treatment. Among PID, the investigators distinguish: pelvi-peritonitis and pelvic collections such as Douglas abscess and/or tubo-ovarian abscess (TOA).

Recent recommendations published in December 2018 by the National College of French Gynecologists and Obstetricians (CNGOF) suggest that it is preferable to drain TOA when their size is greater than 3-4 cm. Ultrasound-guided transvaginal drainage is recommended as first-line treatment because of its ease of performance and its effectiveness. In the literature, many authors have demonstrated the feasibility and efficacy of transvaginal drainage associated with antibiotics in the treatment of TOA. Since ultrasound-guided transvaginal drainage is a less invasive alternative therapeutic procedure than laparoscopy for the drainage of TOA, it would be compatible with outpatient management. This mode of management can be carried out in a dedicated outpatient or functional exploration room with the help of a nurse but without an anesthetic team present. This gesture is simple and short-lived. In addition, the antibiotics used have pharmacological properties allowing oral intake from their initiation.

The investigators have proposed a new service protocol to treat TOA in this outpatient mode. The investigators therefore wish to analyze this new protocol from these three angles: 1/ the feasibility of this care, 2/ the quality of life of the patients through questionnaires given throughout the care and 3/ an evaluation of the 'efficiency.

Detailed Description

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Pelvic inflammatory diseases (PID) require antibiotic treatment. Among PID, the investigators distinguish: pelvi-peritonitis and pelvic collections such as Douglas abscess and/or tubo-ovarian abscess (TOA).

Recent recommendations published in December 2018 by the National College of French Gynecologists and Obstetricians (CNGOF) suggest that it is preferable to drain TOA when their size is greater than 3-4 cm. Ultrasound-guided transvaginal drainage is recommended as first-line treatment because of its ease of performance and its effectiveness. In the literature, many authors have demonstrated the feasibility and efficacy of transvaginal drainage associated with antibiotics in the treatment of TOA. Since ultrasound-guided transvaginal drainage is a less invasive alternative therapeutic procedure than laparoscopy for the drainage of TOA, it would be compatible with outpatient management. This mode of management can be carried out in a dedicated outpatient or functional exploration room with the help of a nurse but without an anesthetic team present. This gesture is simple and short-lived. In addition, the antibiotics used have pharmacological properties allowing oral intake from their initiation.

The investigators have proposed a new service protocol to treat TOA in this outpatient mode. The investigators therefore wish to analyze this new protocol from these three angles: 1/ the feasibility of this care, 2/ the quality of life of the patients through questionnaires given throughout the care and 3/ an evaluation of the 'efficiency.

Conditions

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Abscess Pelvic Inflammatory Disease Pelvic Infection

Study Design

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Observational Model Type

OTHER

Study Time Perspective

PROSPECTIVE

Study Groups

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prospective group - ultrasound transvaginal drainage

Patients with TOA with ultrasound-guided transvaginal drainage with outpatient management

ultrasound transvaginal drainage

Intervention Type PROCEDURE

Ultrasound-guided transvaginal drainage of TOA by a puncture under simple sedation or analgesia with/or under general anesthesia

retrospective group - ultrasound transvaginal drainage

Patients with TOA in 2016, 2017 and 2018 with ultrasound-guided transvaginal drainage in conventional hospitalization

ultrasound transvaginal drainage

Intervention Type PROCEDURE

Ultrasound-guided transvaginal drainage of TOA by a puncture under simple sedation or analgesia with/or under general anesthesia

retrospective group - laparoscopy

Patients with TOA in 2016, 2017 and 2018 with laparoscopy in conventional hospitalization

laparoscopy

Intervention Type PROCEDURE

Laparoscopy for drainage of TOA under general anesthesia

Interventions

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ultrasound transvaginal drainage

Ultrasound-guided transvaginal drainage of TOA by a puncture under simple sedation or analgesia with/or under general anesthesia

Intervention Type PROCEDURE

laparoscopy

Laparoscopy for drainage of TOA under general anesthesia

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Major patient at the time of inclusion
* Patient with diagnosis of TOA with a latero-uterine mass measuring at least 3 cm

Exclusion Criteria

* Patient with severity criteria requiring hospitalization:

* Clinical severity criteria: haemodynamically unstable patient, septic shock, defense or contracture, sepsis, pelviperitonitis
* Comorbidities: diabetic imbalance, curative anticoagulation
* Patient with a formal indication for laparoscopy:

* Diagnostic doubt with suspicion of an associated oncological or digestive pathology
* Presence of an intra-abdominal intrauterine device (IUD)
* Abscess not accessible vaginally
* Patient who does not meet the eligibility criteria for outpatient hospitalization defined by French High Autority of Health
* Patient under guardianship or curatorship
* Patient does not speak French
* Patient not benefiting from social security coverage
* Current pregnancy
* Confirmed allergy to one of the antibiotics (ceftriaxone, metronidazole or doxycycline)
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Nantes University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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CHU Nantes

Nantes, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Dochez Vincent, MD

Role: CONTACT

02 40 08 78 00 ext. +33

Facility Contacts

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Vincent DOCHEZ

Role: primary

Other Identifiers

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RC21_0011

Identifier Type: -

Identifier Source: org_study_id

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