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Lowering Infection Risk after Miscarriage Surgery

August 15, 2019


Each year 10 to 20% of pregnancies end in
spontaneous abortion. In low- and middle-income countries, surgery
is commonly performed to remove retained products of conception. Infection is a serious consequence of surgery. The Antibiotics in Miscarriage Surgery trial
is a double-blind, placebo-controlled, randomized trial conducted in Malawi, Tanzania, Uganda
and Pakistan to evaluate if use of antibiotics before surgery for spontaneous abortion reduces
the risk of pelvic infection. 3412 women with spontaneous abortion at less
than 22 weeks of gestation were randomized 1 to 1 to receive either doxycycline and metronidazole
or placebo two hours before surgery. The primary outcome was pelvic infection within
14 days after surgery. Infection was defined by the presence of 2 or more
of the following: purulent vaginal discharge, pyrexia, uterine tenderness or leukocytosis. This primary outcome was modified during the
trial to include one of these features plus the clinical need to administer antibiotics. This change was made after clinicians observed that
in some participants the suspicion of pelvic infection was high even when only one of the features
of infection was present. The rate of pelvic infection was 4.1% in the
antibiotics group and 5.3% in the placebo group. Using the original strict criteria,
the rate of pelvic infection was 1.5% in the antibiotics group and 2.6% in the
placebo group. There were no significant differences in adverse events between the
two groups. The authors conclude that antibiotic prophylaxis
prior to miscarriage surgery did not reduce the rates of pelvic infection as defined by modified broad criteria, but provided a possible benefit when pelvic infection was defined by strict criteria. Full study results are available at NEJM.org

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