The value of screening and universal antibiotic prophylaxis in the periabortal period

The value of screening and universal antibiotic prophylaxis in

the periabortal period

A.O. Bale

The Royal Oldham Hospital, Obstetrics/Gynaecology,

Oldham, North West, UK

Introduction Each year 210 million

pregnancies occur worldwide, of which an estimated 46 million end in an induced

abortion [WHO 2003]. There were 185,375 legal abortions carried out in England

and Wales in 2000, a rise of 2,125 (1.2%) compared with 1999. Pelvic infection

complicates up to 12% of induced abortions and has an adverse effect on future

reproductive outcome. The presence in the lower genital tract of Neisseria

gonorrhoeae, Chlamydia trachomatis or the anaerobic organisms characterising

bacterial vaginosis is associated with an increased risk of post-abortion

infective morbidity. Meta-analysis of randomized trials has shown that

prophylaxis with antibiotics effective against either Chlamydia trachomatis or

bacterial vaginosis reduces the risk of post-abortion infective morbidity by

around a half. Other strategies that have been advocated for minimizing the risk

of infective morbidity are screening for lower genital tract infections, with

treatment of positive cases only, and a combined strategy where women are

screened for sexually transmitted infections as well as receiving prophylaxis. 

Objectives To review the strategy for prevention of post-abortal infection at a

Fertility Awareness Clinic.

Method A retrospective analysis of patients

attending a Fertility Awareness Clinic for TOP from November 2000 to December

2004. Data was extracted from a Microsoft Access TOP database and calculations

were done with Microsoft Excel.

Results A total of 1600 patients attended the

clinic, during the study period, requesting TOP. Only 1475 (92.2%) eventually

had TOP. Majority of the patients (83.9%) had a surgical induced abortion while

a medical method was used in 16.1%. About 68.1% accepted screening for infection

prior to the procedure. The prevalence of bacteria vaginosis, Chlamydia

trachomatis and Neisseria gonorrhoeae was 9.9%, 5.3%, and 1.0% respectively.

Majority of the patients (99.0%) had prophylactic antibiotics regardless of

acceptance of screening. Post-abortal contraceptive uptake was 77.0%. The most

common methods used were: Implanon (32.7%), IUCD (13.7%), COC (12.5%) and DMPA

(10.1%). Only 42.2% of patients attended the TOP clinic for follow up. About

2.4% of these were managed for post-abortal sepsis.

Conclusion Our study

confirms that a combined strategy of screening for sexually transmitted

infections as well as universal antibiotic prophylaxis is effective in reducing

post-abortal pelvic infection. An advantage of this strategy over the screen and

treat policy is that it allows for better coverage of the population at risk

since compliance with follow up visits cannot always be guaranteed. Furthermore

post-abortal pelvic infection can still occur due to false negative screening

tests or infections not screened for. Although this strategy appears costly at

the outset than the screen and treat policy, there are potential health and

economic benefits from preventing the sequelae of post-abortal sepsis.

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