A RANDOMIZED COMPARISON OF STRATEGIES FOR REDUCING INFECTIVE COMPLICATIONS OF INDUCED-ABORTION

Objectives To determine lower genital tract carriage rates of C. trach omatis, N. gonorrhoeae and bacterial vaginosis among women seeking ter mination of pregnancy. To compare two clinical management strategies f or minimising the risks of infective morbidity after induced abortion. Design Prevalence of infections was assessed by screening women under going abortion. Clinical management strategies were compared by a rand omised trial. Setting The gynaecology departments of four hospitals in Scotland. Participants 1672 women undergoing induced abortion, Interv entions Women randomised to prophylaxis received metronidazole 1 g rec tally before abortion plus doxycycline 100 mg twice daily for seven da ys. Women randomised to screen-and-treat received appropriate antibiot ics only if screening proved positive for one or more infection. Main outcome measures Prevalences of infections; morbidity in the eight wee ks following abortion as assessed by reported symptoms, general practi tioner consultation and prescription rates and hospital re-attendances ; costs to the NHS of alternative managements. Results Prevalence rate s: C. trachomatis 5.6%; N; gonorrhoeae 0.19%; bacterial vaginosis 17.5 %. Overall, women allocated to receive prophylaxis had lower rates of measures of short term infective morbidity than those allocated to scr een-and-treat. These differences only reached statistical significance for women who were reported negative on screening. The direct costs t o the NHS of prophylaxis and screen-and-treat were calculated to be po und 8.17 and pound 18.34 per woman, respectively. Conclusions Prevalen ces of lower genital tract infections which have been implicated in in creased rates of infective morbidity after abortion are similar to tho se reported elsewhere. Universal antibiotic prophylaxis is at least as effective as a policy of screen-and-treat in minimising the risk of s hort term infective morbidity and is far more cost efficient.