Prophylactic antibiotics for preventing genital tract infection in women undergoing surgical procedures for incomplete abortion: a systematic review and meta‐analysis of randomised controlled trials

Abstract

Background Findings about the effect of prophylactic antibiotics in preventing genital tract infection (GTI) associated with surgical procedures used for incomplete abortions are conflicting. Some reported a decrease in infection associated with the use of antibiotic prophylaxis, whereas others found no significant reduction in GTI. Objective To synthesise systematically the evidence on the effect of prophylactic antibiotics compared with placebo in women undergoing surgical procedures for incomplete abortion. Search strategy In February 2020, PubMed, Embase and Cochrane Central for Register of Controlled Trials were searched for relevant published randomised controlled trials. Selection criteria Randomised controlled trials reporting GTI following surgical procedures for incomplete abortion and comparing antibiotic prophylaxis with placebo. Data collection and analysis Meta‐analysis using inverse variance heterogeneity model included subgroup and sensitivity analyses determined a priori were conducted. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Main results A total of 16 178 women who participated in 24 eligible randomised controlled trials published between 1975 and 2019 were included. Pooled estimates showed the risk of GTI following surgical procedures after incomplete abortion was significantly lower among those who had prophylactic antibiotics (relative risk [RR] = 0.72; 95% CI 0.58–0.90; I2 = 49%). There was no significant effect of antibiotics in women in low‐ and middle‐income countries (three studies, 3579 participants, RR = 0.90; 95% CI 0.50–1.62; I2 = 63%), but it was clinically and statistically significant among women high‐income countries (21 studies, 12 599 participants, RR = 0.67; 95% CI 0.53–0.84; I2 = 44%), with a strong level of evidence as assessed by GRADE. Conclusion This study provides evidence that antibiotic prophylaxis is beneficial in reducing post‐abortion GTI among women undergoing surgical procedures for incomplete abortion. More studies are needed from low‐ and middle‐income countries. Tweetable abstract Prophylactic antibiotics after incomplete abortion are effective in reducing GTI. More studies are needed from low‐ and middle‐income countries.

GRADE Use in Evidence Syntheses Published in High-Impact-Factor Gynecology and Obstetrics Journals: A Methodological Survey

“…In total, 41 SRs analyzed evidence from RCTs only ( n = 41) [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 ] and 18 NRSs only [ 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 <...…”

Authors’ response to: Re: ‘Prophylactic antibiotics for preventing genital tract infection in women undergoing surgical procedures for incomplete abortion: a systematic review and meta‐analysis of randomised controlled trials’

“…We thank Thiel and Rattray 1 for their interest in our publication 2 . We agree that there is a paucity of evidence on the effect of prophylactic antibiotics in women undergoing surgical procedures for incomplete abortion.…”

Early termination of pregnancy in AVN Hip: A unique case

“…Consequently, as a prophylactic measure, a single dose of doxycycline was administered. 7 Due to the patient's inability to abduct her left limb, we encountered challenges in positioning her in the lithotomy position using the conventional leg holder. Consequently, we made adjustments to the patient's position, opting for position without the use of a holder or stirrups.…”