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.
Doxycycline ; Dilatation And Curettage ; Spontaneous Abortion ; Incomplete Abortion ; Vacuum Curettage ; Antibiotic Prophylaxis ; Pelvic Inflammatory Disease

A total of 270 women, all except 1 undergoing episiotomy and episiorrhaphy during vaginal delivery from June 17, 2005 until July 27, 2005 at the Philippine General Hospital, were randomly assigned to use either Chlorhexidine Digluconate, Povidone-lodine or Lactic Acid as antiseptic genital wash during and after the surgical procedure. All participants were asked to come back 1, 2, 4 and 6 weeks after discharge. Assessment was done comparing the efficacy, acceptability and safety of the three antiseptic solutions in preventing surgical site infection. Details of the surgical procedure that might have affected outcomes were also investigated. The results showed that all three antiseptic solutions were rated moderately to extremely acceptable by most of the participants. All three antiseptic solutions were equally safe. Adverse events were rare, mild and self limited. The three serious adverse events in the study were related to the pregnancy of the participants and not to the antiseptic solutions. Details of the surgical procedure that are not comparable among the 3 groups and thus seem to influence outcomes are the level of expertise of the surgeon, breaks in asepsis and severity of the accidental lacerations in the operative site. However, data on the eight participants who developed SSI did not confirm this-all these 8 cases were operated on by residents, did not have break in asepsis, and only one had laceration and the depth was reported to be subcutaneous. The duration of the operation, the amount of estimated blood loss, the type and amount of sutures used and the specific place where the surgery was performed are similar in the three groups. It appeared that oral systemic antimicrobials traditionally and commonly used for patients undergoing episiotomy and episiorrhaphy were unnecessary, and that generally good outcomes in terms of preventing surgical site infections can be obtained with the use of topical antiseptic solutions alone. Finally, compared to Povidone Iodine, and more so with lactic acid, the number of surgical site infections was found to be least in participants who used Chlorhexidine digluconate as antiseptic genital wash during and after the surgical operation. (Author)

Chlorhexidine ; Episiotomy ; Povidone-iodine ; Lactic Acid ; Anti-infective Agents, Local ; Women