Prophylactic Antibiotics in Women with a History of Pelvic Inflammatory Disease Undergoing First‐Trimester Abortion

Abstract

In a double-blind controlled trial the effect of prophylactic metronidazole on postabortal infection in women with a history of pelvic inflammatory disease (PID) was assessed. One hundred and thirty-five women were eligible for randomization, of whom 17 were excluded. The regimen consisted of oral metronidazole 400 mg 1 h before the abortion and again 4 and 8 h after, or else placebo. In the placebo group the rate of postabortal PID was 13.0% (7/54) and in the metronidazole group 10.9% (7/64), a nonsignificant difference (p greater than 0.7). Women in gestational weeks 11-12 had a significantly increased rate of postabortal PID compared with women in weeks 6-10 (p less than 0.005), but this rate was not influenced by the treatment (p greater than 0.2). Women with parity 1 had a significantly increased rate of postabortal PID compared with women with parity 0 (p less than 0.05), but again the treatment did not influence this rate significantly (p greater than 0.2). The number of hospital days for women in the metronidazole group did not differ significantly from that in the placebo group (p less than 0.1). The amount of metronidazole administered for prophylactic and postabortal treatment was significantly greater in the metronidazole group (p less than 0.001). The amounts of other antibiotics prescribed showed non-significant differences between the two groups (all p-values greater than 0.3).

The Influence of Cervical Dilatation by Laminaria Tent and with Hegar Dilators on the Intrauterine Microflora and the Rate of Postabortal Pelvic Inflammatory Disease

“…The distribution of endometritis and salpingitis was not significantly different between the laminaria group and the controls. The incidence of postabortal PID was significantly higher in the two groups in cases where gestational age was of 10-12 weeks than where it was 5-9 weeks, a finding in accordance with those of a Danish series (11). In a Norwegian study, the incidence of postabortal PID was highest in pregnancies of less than 9 weeks gestational age (9).…”

“…Our findings are in accordance with those of others (43). In yet another earlier study, nulliparous women under 20 years of age were found to be at the greatest risk of postabortal PID (11). In this study, perforations occurred in 1.1% of the control group as compared to the figure of 0.5% reported by others (9,lO).…”

“…Previous reports have varied in their documentation of the frequency of PID, following induced abortion in Scandinavia from about 3% (9,lO) to 13% (11). This wide variation may be partly due to the definition of PID, a heterogenous concept generally based on vague symptoms and signs (11).…”

Somatic Complications And Contraceptive Techniques Following Legal Abortion

“…In the present study, we found that 6.7% of the patients tested for C. trachomatis were positive, which is in the same range as that found by Moller et al . Assuming that no cultures had been taken, the total rate of complications would have been expected to increase by approximately 2%, since the frequency of postabortal PID in untreated women who have positive cultures is reported to be 23-33'70 (17). Several studies have examined the prophylactic use of antibiotics in order to reduce the rate of postabortal PID, and decreases in the incidence of up to 50% have been reported (16,lS).…”

“…Patients who used pessary, vaginal contraceptive sponge or intrauterine device are not included in the figure. showed a low number of patients (90/0) in the group [15][16][17][18][19] years. The largest groups were those between 20-24 and 25-29 years of age, comprising 25v0 and 26qo of the patients, respectively.…”