(Obstet Gynecol. 2019;133:149–154)
There is no consensus on terminology regarding first-trimester pregnancy loss (<10 wk of gestation) in the literature. Consequently, the terms miscarriage, spontaneous abortion, and early pregnancy loss are often used interchangeably. It is quite possible that this variability in terminology has contributed to previously reported patient dissatisfaction with health care provider communication during the time of loss diagnosis. To gain insight into the patient experience and address this area for improvement, the authors of the present study surveyed women experiencing first-trimester pregnancy loss in a multisite, randomized trial.
Materials and Methods: A Markov model of antibiotic side effects, infection and infection sequelae (ectopic, chronic pain and infertility) was developed. Three options were considered: no antibiotics, prophylactic antibiotics (pre-abortion single-dose) and treatment-dose antibiotics (postabortion multiple-dose). Two models were run using either a 20-year-old or a 30-year-old woman who desires children in the future. One-way, two-way and Monte Carlo sensitivity analyses were performed. A $50 000 per quality-adjusted life year threshold was used for cost-effectiveness. Results: For a 20-or 30-year-old woman, no antibiotic is favored if the baseline infection risk is b 0.6% or b 0.8%, respectively. Treatment-dose antibiotics is favored if the risk of infection exceeds 3.7% or 4.8%, respectively. Otherwise, prophylactic antibiotics are favored. Discussion: Results were sensitive to varying relative infection risk between prophylactic and treatment regimens but were robust to variation of other cost and outcome parameters. Conclusion: Further study is needed to examine antibiotic use in settings with a low incidence of postabortal infection and to compare prophylactic and treatment regimens directly. Further delineation of the sequelae of postabortal infection is also needed.
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