**Core Concept**
Tubercular pelvic inflammatory disease (PID) is a rare but serious complication of tuberculosis (TB) affecting the female reproductive organs. The mode of spread in tubercular PID is primarily hematogenous, involving the transmission of Mycobacterium tuberculosis from the primary site of infection to the pelvic organs through the bloodstream.

**Why the Correct Answer is Right**
The hematogenous spread of TB to the pelvic organs is facilitated by the presence of tubercle bacilli in the bloodstream, which then infect the endometrium, fallopian tubes, and ovaries. This process is thought to occur through the venous drainage of the lungs, where the primary site of TB infection is located. The infected blood then flows to the pelvic organs, leading to inflammation and damage.

**Why Each Wrong Option is Incorrect**
**Option A:** Lymphatic spread is not the primary mode of spread in tubercular PID, although it can occur in some cases. Lymphatic spread would more likely involve the regional lymph nodes near the site of infection.
**Option B:** Direct inoculation is not a typical mode of spread in tubercular PID, as the infection is usually acquired through inhalation of TB bacilli, which then spread to the pelvic organs through the bloodstream.
**Option C:** Contiguous spread is not a common mode of spread in tubercular PID, as the infection typically originates from a distant site, such as the lungs, rather than from an adjacent organ.

**Clinical Pearl / High-Yield Fact**
Tubercular PID is often associated with chronic pelvic pain, infertility, and recurrent abortions, making it essential to consider TB as a differential diagnosis in patients with pelvic pain and infertility.

**Correct Answer: A. Hematogenous spread.**