A randomised controlled trial of prophylaxis of post‐abortal infection: ceftriaxone versus placebo

Abstract

Objective To investigate the incidence of post‐operative infection after first trimester abortion in women treated with a long‐acting cephalosporin (ceftriaxone) compared with low risk patients receiving no treatment and with high risk patients receiving our standard treatment of ampicillin/pivampicillin and metronidazole. Design A prospective, randomised controlled trial. Setting Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Denmark. Subjects Nine hundred and ninety‐six women, admitted on an outpatient basis for legal termination of pregnancy at 12 weeks or less of gestation, were included in the study after giving informed consent. The women were divided into high risk and low risk categories and allocated either to treatment with ceftriaxone or to standard treatment. For high risk patients the standard treatment was initiated by a peroperative injection of ampicillin and metronidazole, followed by oral doses of metronidazole and pivampicillin three times daily for four days. No prophylactic antibiotics were given to the women randomised to standard treatment in the low risk group. Interventions All women were kept under observation, and, between six and 14 days post‐operatively, underwent pelvic examination. Clinical endpoints were noted. Main outcome measures Post‐operative pelvic inflammatory disease in women applying for legal first trimester abortion. Results Seven hundred and eighty‐six women fulfilled the criteria for evaluation. A tendency toward a prophylactic effect of ceftriaxone was observed in most clinical findings. A significant prophylactic effect of ceftriaxone was found in the low risk group. Conclusions This study demonstrated a significant reduction in post‐operative pelvic inflammatory disease in low risk patients, who were applying for legal first trimester abortion, treated peroperatively with ceftriaxone. No significant difference was demonstrated between high risk patients treated with ceftriaxone or ampicillin/pivampicillin and metronidazole.

Complications from first-trimester aspiration abortion: a systematic review of the literature

“…Fourteen of the 23 studies reported ≥5.0% of cases later developed infections requiring outpatient antibiotics, although seven studies did not explicitly report outpatient treatment for non-hospitalized cases of endometritis and PID [36,37,[40][41][42]50,54]. Most studies in which ≥5.0% of women received outpatient treatment for infection noted that women were tested for Chlamydia prior to the procedure, and two provided antibiotic prophylaxis to those with positive results [39,46].…”

“…The majority of hospital-based studies reported ≥1.0% of women hospitalized for complications, and many were conducted in Scandinavian countries in the 1980's and early 1990's. Women in these studies were hospitalized primarily to treat PID or for abdominal procedures; one study did not specify the reasons for hospitalization [54], and two others noted that some women experiencing complications were hospitalized for 'social' or 'geographic' reasons, [36,45] suggesting that the percentages reported may not reflect the women were screened prior to the procedure, and those who were not considered good candidates for deep sedation (e.g., body mass index >40kg/m 2 , poorly controlled seizure disorder or asthma) or who did not follow fasting guidelines were referred to a hospital or had the procedure performed using local anesthesia.…”

Blood Pressure and Retinal Microvascular Characteristics During Pregnancy

“…8,[10][11][12] Both measurements were separately taken 2 times with bare feet. If the first 2 measurements differed by 1 cm or 200 g for height or weight, a third measurement was taken for the average calculation.…”

“…10 It has been reported that endothelium-dependent vasodilation is increased in women who have preeclampsia to levels over and above those seen in normal pregnancy. 11 Nonetheless, whether maternal blood pressure is associated with microvascular changes that may lead to poor maternal and neonatal outcomes is uncertain because of a lack of means to visualize and assess the microcirculation directly. Over the last decade, the retinal microcirculation has been established as a "biological model" to study the human microcirculation in vivo.…”

Antibiotic prophylaxis for selected gynecologic surgeries

“…Eight randomized trials on antibiotic prophylaxis for first‐trimester suction curettage and 1 randomized trial involving second‐trimesterdilation and evacuation were identified [11–19]. No trials of dilation and curettage without products of conception met the inclusion criteria.…”