A randomized trial on the prophylactic use of doxycycline after curettage and manual vacuum aspiration in incomplete, non-septic, spontaneous abortion.
- Author:
Ma Lorena L SANTOS
;
Guadalupe N VILLANUEVA
- Publication Type:Journal Article, Original
- Keywords:
AbortionPelvic Infection
- MeSH:
Doxycycline;
Dilatation And Curettage;
Spontaneous Abortion;
Incomplete Abortion;
Vacuum Curettage;
Antibiotic Prophylaxis;
Pelvic Inflammatory Disease
- From:
Philippine Journal of Obstetrics and Gynecology
2007;31(1):24-30
- CountryPhilippines
- Language:English
-
Abstract:
Objective: To be able to determine whether prophylactic doxycycline at completion curettage or manual vacuum aspiration for incomplete, spontaneous, non-septic abortion decreases the rate of postoperative pelvic infection. Study Design: This is a prospective randomized controlled trial (no blinding, prophylaxis versus no prophylaxis), between March 1,2005 to June 15,2005. Patients presenting with nonseptic, spontaneous, incomplete abortion were recruited. Those who will fulfilled the following criteria were included in the study: pregnancy less than 12 weeks, no clinical signs of genital infection, hemodynamically stable, no antibiotic treatment during the three weeks before the abortion, and no suspected allergic reactions to tetracyclines. Participants were allocated randomly to two groups: 1) antibiotic or treatment group (4 tablets of 100mg doxycycline, 400mg, 30minsto1 hour before the procedure, 2) no treatment or control group. All patients received aseptic curettage and manual vacuum aspiration procedures. At follow-up, a diagnosis of infectious morbidity would be recorded if any two or more of the following signs or symptoms were found: 1) pelvic inflammatory disease, 2) uterine, adnexal or cervical tenderness, and 3) leukocytosis >15,000/cu mm. Statistical analysis usedttestand chi-square test to note for differences between the two groups. Results: Two hundred forty patients were randomized. The differences in age distribution, parity, gestational age, anaesthetic method and method of uterine evacuation were insignificant between the two groups. Forty six out of the 240 patients presented with signs and symptoms of pelvic inflammatory disease after the uterine evacuation, giving a postoperative pelvic inflammatory disease rate of 19.1 percent. Majority of the patients belonging to the control group (42/123=34.1 percent) developed more infectious morbidity (lower abdominal pain, fever, leucorrhea, adnexal mass, elevated ESR, and leukocytosis) as compared to the doxycycline group (4/117=3.4 percent). Disregarding treatment, an infection rate of 10.55 percent was recorded in the group with previous pelvic inflammatory disease, as compared with 8.18 percent in the group without previous infection (RR=1.29). Conclusion: In our population of patients with incomplete, nonseptic, spontaneous abortion, prophylactic doxycycline prior to curettage or manual vacuum aspiration decreased the rate of postoperative pelvic infection. Prophylactic antibiotics proved to be a protective factor, reducing the rate of complications, most especially noted amongst the group of patients who had previous history of pelvic inflammatory disease and those who had multiple sexual partners.
