Risk factors in wound infections after laparotomy in obstetrics and gynaecology.

BACKGROUND: The objectives of the study are to obtain risk factors for and rates in postoperative wound infections in order to develop an infection surveillance program. METHODS: A retrospective, case-controlled three-year study of wound infections in Caesarean sections and gynaecological laparotomies with 15 predictive variables. For each patient and variable, the likelihood ratio of having infection was calculated. The prior odds of infection were iteratively combined by a set of predictive variables to establish the posterior probability of being infected. A patient was classified as pathological if the posterior probability was above 0.5 and as normal if the posterior probability was below 0.5. The squared risk of misclassification was used as indicator of the goodness of classification. RESULTS: Ruptured membranes prior to Caesarean section classified 88% of the patients correctly. For gynaecological laparotomies body mass index classified 76% of the patients correctly. The remaining predictive variables added little to improve the classification. CONCLUSIONS: Infection surveillance programs may reduce wound infection rates and have been recommended because they offer increased service quality, safer guidance for the implemantation of preventive measures, and better patient information. We have demonstrated that the number of predictive variables necessary in registering Caesarean sections can be limited to one or two, and in gynaecological laparotomies to one to three.

Ampicillin-metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial.

OBJECTIVE: To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity. DESIGN: Randomised controlled double-blind trial. SETTING: Six obstetric departments in the Copenhagen area. POPULATION: One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation. METHODS: Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo. MAIN OUTCOME MEASURES: Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections. RESULTS: Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42% versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40% versus 63%, P < 0.05), when compared with placebo treatment. Antibiotic treatment had no significant effects on infectious morbidity. CONCLUSIONS: Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.

Hernias in trocar ports following abdominal laparoscopy. A review.

BACKGROUND: With increasing numbers of laparoscopies in gynecologic surgery as well as the use of larger trocars more post-operative hernias can be expected. Most hernias occur as Richter's hernias without peritoneal lining and contain small or large intestines or omentum. The incidence is around 1%, but rising with increasing size of trocars. About one fourth of hernias are umbilical, the rest located extraumbilical. RESULTS: The diagnosis is typically based on the presence of vomiting or nausea with an extended and painful abdomen within two weeks of surgery and can be established by a small bowel series. However, the course can be prolonged and ileus can occur up to one year following laparoscopy. In the majority of cases the hernial content was small intestines or omentum. CONCLUSIONS: In order to reduce the frequency of trocar hernias it is recommended to apply small trocars. Fascial closure must be done when trocars of 10 mm or larger have been employed and the surgeon must ensure that peritoneal tissue is not drawn into the trocar canals when removing the probes. Also, umbilical hernias must be ruled out and, if found, closure must include the complete fascial defect. There are several techniques available for fascial closure. It is concluded that all precautions including fascial suturing must be taken to reduce the 1% incidence of post-laparoscopy hernias.

[Factors influencing incidence of spontaneous abortion, dyspareunia, dysmenorrhea and chronic pelvic pain]. / Faktorer med indflydelse på hyppigheden af spontan abort, dyspareuni, dysmenoré og kroniske underlivssmerter.

The aim of this study was to investigate the association between on the one hand pelvic inflammatory disease (PID), induced abortion, postabortal complications and age and on the other the rate of spontaneous abortion. The influences of PID, induced and spontaneous abortion, postabortal complications, age and parity on the rates of dyspareunia, dysmenorrhea and chronic pelvic pain were also investigated. Questionnaires were given to all women referred for delivery and induced first-trimester abortion to the Department of Obstetrics and Gynaecology at Gentofte hospital during the period January-May 1988. Altogether 1229 women answered the questionnaire, 868 were referred for delivery and 361 for induced abortion. In 839 women without previous induced abortion, a history of PID was associated with an increased risk of spontaneous abortion (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.03-2.33); women above the age of 33 had a lower risk of spontaneous abortion (OR 0.53, 95% CI 0.30-0.96). In 382 women with previous induced abortion, the influence of age on the rate of spontaneous abortion was continuous so that an increase of one year of age reduced the risk of spontaneous abortion by 0.91 (95% CI 0.85-0.96). Women with any previous PID when compared to those without, more often had dyspareunia (14 versus 3%, OR 3.87, 95% CI 2.35-6.37) and chronic pelvic pain (six versus 0.4%, OR 13.07, 95% CI 10.09-16.04). Age was inversely associated with the incidence of dysmenorrhea (OR 0.94, 95% CI 0.91-0.97). We conclude that PID is associated with spontaneous abortion, whereas age correlates inversely with the rate of spontaneous abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors influencing spontaneous abortion, dyspareunia, dysmenorrhea, and pelvic pain.

OBJECTIVE: To investigate the following: 1) the influence of pelvic inflammatory disease, postabortal complications, previous induced abortions, and age on the rate of subsequent spontaneous abortion; and 2) the influence of pelvic inflammatory disease, postabortal complications, previous induced abortions, previous spontaneous abortions, age, and parity on the rates of dyspareunia, dysmenorrhea, and chronic pelvic pain. METHODS: The study population consisted of a cohort of 1229 pregnant women, of whom 868 were referred for delivery and 361 for first-trimester abortion. Outcome measures examined were spontaneous abortion and the occurrence of dyspareunia, dysmenorrhea, and chronic pelvic pain. RESULTS: In 839 women without previous induced abortion, a history of pelvic inflammatory disease was associated with an increased risk of spontaneous abortion (odds ratio 1.55, 95% confidence interval [CI] 1.03-2.33); women above age 33 had a lower risk of spontaneous abortion (odds ratio 0.53, 95% CI 0.30-0.96). In 382 women with previous induced abortion, the influence of age on the rate of spontaneous abortion was continuous so that an increase of 1 year of age reduced the risk of spontaneous abortion by 0.91 (95% CI 0.85-0.96). Women with any previous pelvic inflammatory disease, when compared with those without, more often had dyspareunia (14 versus 3%; odds ratio 3.87, 95% CI 2.35-6.37) and chronic pelvic pain (6 versus 0.4%; odds ratio 13.07, 95% CI 10.09-16.04). Age was inversely associated with the incidence of dysmenorrhea (odds ratio 0.94, 95% CI 0.91-0.97). CONCLUSION: Pelvic inflammatory disease is associated with later spontaneous abortion, whereas age correlates inversely with the rate of spontaneous abortion. Spontaneous and postabortal pelvic inflammatory diseases carry significantly elevated risks of dyspareunia and chronic pelvic pain.

[Preventive antibiotics in induced first-trimester abortion]. / Profylaktisk antibiotika ved abortus provocatus i første trimester.

The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were 5,400 Dkr (approximately pounds 500) in Denmark in 1979. Sequelae of postabortal infection are similar to and occur with the same frequency as sequelae to "spontaneous" pelvic inflammatory disease. Thus, secondary infertility was found in 10% of women with postabortal infection, spontaneous abortion in 22%, dyspareunia in 20%, and chronic pelvic pain in 14%. The risk of ectopic pregnancy is probably also increased. Surgical scrub cannot sterilize the endocervix and, as a consequence, abortion is performed in a contaminated field. The presence of pathogenic bacteria, i.e. Chlamydia trachomatis, therefore increases the risk of postoperative infection. The organism is found in approximately 7% of those applying for abortion and the risk of sustaining infection is 20%. Other risk factors are previous pelvic inflammatory disease, vaginal infection, first pregnancy and young age. Prophylactic antibiotics halve the incidence of infection, but by applying prophylaxis to risk groups only, the amount of prescriptions can be reduced. Prophylaxis need only be administered peroperatively, and tetracyclines, metronidazol, and penicillin/pivampicillin have been found to be effective. Women applying for abortion should be examined for C. trachomatis and positive cases treated no later than at the time of the abortion.

[Induction of early first trimester abortion with a prostaglandin E1 analogue. A pilot study]. / Fremkaldelse af abort tidligt i 1. trimester med prostaglandin-E1 analog. En pilotundersøgelse.

A pilot investigation employing prostaglandin (PG) induced early abortion (maximal 56 days of menostasia) was planned with the object of investigation whether this non-surgical method was as effective, safe and acceptable as vacuum aspiration. The investigation was planned to include 20 women to be treated with 1 mg PGE1-vagitories at intervals of three hours up to five times in 24 hours. If abortion did not occur after 24 hours as assessed by gynaecological examination and sonography, the uterus was evacuated. After seven women had participated, the investigation was abandoned because of complications and violent pain in several women and because very few of the woman ashed to participate desired to do so, i.e. they preferred vacuum aspiration under general anaesthesia. It is concluded that the method employed here did not prove acceptable for Danish women on account of the severe pain involved and the protracted course of the procedure.

Preventive lymecycline therapy in women with a history of pelvic inflammatory disease undergoing first-trimester abortion: a clinical, controlled trial.

In a clinical, controlled trial 55 women with a history of pelvic inflammatory disease (PID) undergoing first-trimester abortion were randomized to either lymecycline therapy or placebo. Twenty-four women received lymecycline capsules 300 mg b.i.d. for 14 days starting on the morning of the abortion and 31 received similar placebo medication. In the lymecycline group 2 women (8.3%) and in the placebo group 7 (22.6%) contracted postabortal PID, a non-significant difference (p greater than 0.2). The variables age, gestational age, number of spontaneous abortions, births and episodes of PID, and Hegar size were not associated with the rate of postabortal PID. Women without previous induced abortions had a significantly increased rate of postabortal infection (p = 0.02), but the treatment did not influence this rate. Three women had a positive culture for Chlamydia trachomatis at the time of abortion and two of these had postabortal PID. None of 7 women with postabortal PID had significant increases in IgA, IgG or IgM chlamydia antibody titers, but two women with uncomplicated abortions had serological evidence of infection. The number of hospital days and amounts of antibiotics prescribed to women with postabortal PID were not significantly different between the two treatment groups (p greater than 0.05). Women with a history of PID had an elevated risk of postabortal PID warranting the use of some sort of prophylaxis, and screening for C. trachomatis in an abortion population is recommended.

PIP: To assess the efficacy of prophylactic antibiotics on postabortal infection in women with a history of pelvic inflammatory diseases (PID), 55 such women undergoing 1st-trimester pregnancy termination were randomly assigned to receive either lymecycline therapy or placebo. Chlamydial antibodies were investigated in all women before and after the abortion. 24 women received 300 mg lymecycline capsules for 14 days, starting on the morning of the abortion procedure; the remaining 31 women received placebo medication on the same schedule. Postabortal PID occurred in 2 women (8.3%) in the lymecycline group and 7 women (22.6%) in the placebo group--a nonsignificant difference. Age, gestational age, number of spontaneous abortions, births, previous episodes of PID, Hegar size, and the presence of C trachomatis did not influence the rate of postabortal PID. Although women with no previous abortions had a significantly higher rate of infection, this rate was not influenced by the preabortion treatment mode. C trachomatis was identified in 3 of 53 women for whom cultures were obtained; 2 of these women contracted postabortal PID. None of the 7 women with postabortal PID had significant increases in IgA, IgG, or IgM chlamydia antibody titers, although 2 women with uncomplicated abortions had serologic evidence of infection. Use of lymecycline did not significantly reduce the number of hospital days or amounts of antibiotics required among women with postabortal PID. Overall, the high rate of postabortal PID recorded in this study among women with a history of PID (23%) supports the use of some sort of prophylactic method. Since these women do not seem to harbor chlamydial infection more often than women without previous PID, penicillin or ampicillin may be effective.

Pelvic inflammatory disease following induced first-trimester abortion. Risk groups, prophylaxis and sequelae.

PIP: An analysis of published studies of the effect of antibiotic prophylaxis associated with vacuum aspiration abortion includes an examination of risk factors for pelvic inflammatory disease (PID), cervical and vaginal flora present in early pregnancy and in PID, the effect of surgical scrub and of prophylaxis on flora, principles of antibiotic prophylaxis, and economic costs of PID. From several prospective studies, it is clear that nulliparas, women with a history of PID, those bearing Chlamydia trachomatis are at risk of post-abortion infection. No risk was associated with pelvic pain, dysmenorrhea, social class, insertion of an IUD, or timing of resumption of coitus. After an extensive enumeration of microbes found in nonpregnant, pregnant, and PID female genital tracts, it was concluded that only C. trachomatis and N. gonorrheae are clearly associated with PID, while the importance of several other microbes is unclear. Quantitative counts of organisms in any condition are lacking. PID is polymicrobial; different organisms probably account for noniatrogenic PID and post-surgical PID. There is evidence that surgical cleansing of the vagina has no bearing on incidence of post-abortal PID, since the responsible organisms come from the endocervix. 5 controlled clinical trials demonstrated that antibiotic prophylaxis is warranted; that penicillin/ampicillin selectively reduced PID in women with PID history; that imidazoles preferentially reduce PID in the general population without PID history. No lasting side effects or emergence of resistant organisms was reported. The treatment was cost effective, cutting health costs and labor losses 5-8%, and reducing the incidence of spontaneous abortion, secondary infertility, and chronic pain.^ieng

Early complications after induced first-trimester abortion.

Complications subsequent to 5,851 consecutively induced first-trimester abortions during the period 1980-85 were analysed. Three hundred and fifty-six abortions (6.1%) led to complications requiring hospital admission. According to bivariable analysis, women below 25 years of age, women with parity 0, women with no spontaneous and with no induced abortions, and women in gestational week 8 had significantly higher postabortal complication rates than women 25 years of age and older (p less than 0.001), women with previous births (p less than 0.0001), women with spontaneous abortions (p less than 0.005), women with induced abortions (p less than 0.005), and women in other gestational age groups (p less than 0.0005). The mean stay in hospital per complicated abortion was 5.3 days. It was discussed whether the administration of prophylactic antibiotics to women with a history of pelvic inflammatory disease and young women completing their first pregnancy could reduce the complication rate.

PIP: The number of complications subsequent to 1st trimester abortion performed during the past 6 years at the Department of Gynecology and Obstetrics, University Hospital, Copenhagen, at Hvidovre, were evaluated. The associations between the women's age, obstetric history, gestational age, and the rate of early postabortal complications were analyzed. The number of hospital days spent because of such complications was calculated. All 1st trimester abortions performed at University Hospital during the January 1980 to November 1985 period were included. All procedures were performed under general anesthesia by dilatation with Hegars dilators and vacuum aspiration after cleansing of the perineum and vagina. Following aspiration, blunt curettage was performed to ensure that the uterine cavity was empty. Intravenous doses of methylergometrin 0.2 mg were administered. 85% of the women were discharged the same day and 15%, mostly for social reasons, on the following day. 5851 1st trimester abortions were performed. 356 abortions (6.1%) were complicated by 1 or several of the following complications: pathologic bleeding with or without recurettage; temperature; pelvic inflammatory disease (PID) requiring antibiotic therapy; uterine perforation; cervical injury requiring suture; continued pregnancy; and readmission without therapy. The distribution of complications in the 356 women showed significantly more complications in women in the age groups younger than 19 and 20-24 years than in other women. For 353 women, the distribution showed significantly more complications in women with parity 0 vis-a-vis parity greater than 1. In 353 and 354 women, respectively, there were significantly more complications in women with no previous spontaneous or induced abortion than in women with 1 or more spontaneous or induced abortions. In 356 women the distribution showed significantly more complications in women in gestational week 8 than in other women. Only 1 woman required blood transfusion because of perioperative bleeding. 1889 hospital days were registered following 356 complicated abortions. The total complication rate of 6.1% compares favorably with the results of recent large investigations of abortion populations.

The role of vaginal secretory immunoglobulin A, Gardnerella vaginalis, anaerobes, and Chlamydia trachomatis in postabortal pelvic inflammatory disease.

In a prospective study of 129 women undergoing induced first-trimester abortion, 14 (10.9%) contracted postabortal pelvic inflammatory disease (PID). Samples of vaginal secretion for quantitation of secretory immunoglobulin A (sIgA) as well as isolates from cervix/urethra for the culture of anaerobes and aerobes, including Bacteroides fragilis et melaninogenicus and Gardnerella vaginalis, were obtained at the preoperative visit. Two blood samples from each woman with postabortal PID were analysed for antibodies against G. vaginalis. Twenty-five per cent of women with a history of PID developed postabortal PID, and 25% with vaginitis contracted postabortal infection (p less than 0.001 and p less than 0.005). Twenty-five per cent of women harboring C. trachomatis at the time of abortion developed infection. The presence of anaerobes or G. vaginalis was not associated with the frequency of postabortal PID (all p-values greater than 0.1). One woman with postabortal PID produced a culture positive for G. vaginalis and a rise in specific antibody titer. The levels of vaginal sIgA were not significantly associated with a positive history of PID (p greater than 0.6), with postabortal PID (p greater than 0.4) or with the presence of anaerobes or G. vaginalis at the time of abortion (p greater than 0.3). However, significantly elevated levels of sIgA were found in women harboring C. trachomatis (p less than 0.05). Thus, the study could not demonstrate any correlation between vaginal sIgA and PID, but increased sIgA in Chlamydia-positive women. A history of PID and vaginitis entailed a significant risk of contracting postabortal PID.

Prophylactic antibiotics in women with a history of pelvic inflammatory disease undergoing first-trimester abortion.

In a double-blind controlled trial the effect of prophylactic metronidazole on postabortal infection in women with a history of pelvic inflammatory disease (PID) was assessed. One hundred and thirty-five women were eligible for randomization, of whom 17 were excluded. The regimen consisted of oral metronidazole 400 mg 1 h before the abortion and again 4 and 8 h after, or else placebo. In the placebo group the rate of postabortal PID was 13.0% (7/54) and in the metronidazole group 10.9% (7/64), a nonsignificant difference (p greater than 0.7). Women in gestational weeks 11-12 had a significantly increased rate of postabortal PID compared with women in weeks 6-10 (p less than 0.005), but this rate was not influenced by the treatment (p greater than 0.2). Women with parity 1 had a significantly increased rate of postabortal PID compared with women with parity 0 (p less than 0.05), but again the treatment did not influence this rate significantly (p greater than 0.2). The number of hospital days for women in the metronidazole group did not differ significantly from that in the placebo group (p less than 0.1). The amount of metronidazole administered for prophylactic and postabortal treatment was significantly greater in the metronidazole group (p less than 0.001). The amounts of other antibiotics prescribed showed non-significant differences between the two groups (all p-values greater than 0.3).

Blood and milk concentrations of ampicillin in mothers treated with pivampicillin and in their infants.

The levels of ampicillin were determined in milk and plasma of 14 lactating mothers in treatment with pivampicillin for puerperal infections and in plasma of their suckling infants. Ampicillin could not be detected in plasma of the infants, i.e. all levels were less than 0.03 micrograms/ml. Maximum levels occurred in plasma 60-120 minutes and in milk 180-240 minutes after medication. Milk-plasma ratios varied between 0.01 and 0.58. The highest level of ampicillin in milk was 1.02 micrograms/ml in a woman receiving pivampicillin tablets 700 mg t.d.s. At this level an infant can at the most ingest 0.5 mg/day. This dose is too small to cause any symptoms in the suckling infants, but allergic sensibilization through the milk is possible.

Comparison of preventive use of metronidazole and ampicillin in women with a history of pelvic inflammatory disease undergoing first-trimester abortion.

In a double-blind controlled trial the efficacy of prophylactic metronidazole and pivampicillin to women with a history of pelvic inflammatory disease (PID) undergoing first-trimester abortion was assessed. Thirty-eight women received pivampicillin tablets 350 mg and 43 women metronidazole tablets 400 mg, given 1 h before and 4 and 8 h after the abortion. In the pivampicillin group 5 women (13.1%) and in the metronidazole group 8 women (18.6%) developed post-abortal PID, a non-significant difference (P greater than 0.05). The number of hospital days and amounts of antibiotics were not significantly different in the two treatment groups (all P-values greater than 0.05). Women with a history of PID were found to be at risk of contracting postabortal PID.

Sequelae of induced first-trimester abortion. A prospective study assessing the role of postabortal pelvic inflammatory disease and prophylactic antibiotics.

A follow-up study was undertaken in 493 women who had participated in a clinical, controlled trial with the object of assessing the role of postabortal pelvic inflammatory disease and prophylactic antibiotics in the development of sequelae. Information about dysmenorrhea, dyspareunia, chronic pelvic pain, episodes of pelvic inflammatory disease, infertility, births, induced and spontaneous abortions, and ectopic pregnancies were obtained from 382 of the women and from 38 of 40 women who had contracted postabortal pelvic inflammatory disease during the previous study. Significantly elevated rates in women with postabortal pelvic inflammatory disease compared with women without this disease were found for spontaneous abortion (22% versus 5%, p less than 0.0005), secondary infertility (10% versus 2%, p less than 0.05), dyspareunia (20% versus 5%, p less than 0.005), and chronic pelvic pain (14% versus 2%, p less than 0.001). Nonsignificant differences were observed for ectopic pregnancy and dysmenorrhea. A new episode of pelvic inflammatory disease within the first year after abortion was observed more often in women with postabortal pelvic inflammatory disease than in women without infection (41% versus 5%, p less than 0.0001). Prophylactic antibiotics decreased the rates of spontaneous abortion and dyspareunia (p less than 0.05 in both instances).

Midtrimester abortion by intracervical prostaglandin E2.

Seventy-six consecutive patients undergoing midtrimester abortion were randomly divided into treatment with either intracervical and (less so) extraamniotic prostaglandin E2 (PGE2) gel or intraamniotic prostaglandin F2 alpha (PGF2 alpha). At the end of 5 h the initial treatment was supplemented by an oxytocin drip and in the PGE2 group the intracervical application of gel was repeated if necessary. The second day a third application of PGE2 gel was administered to a few women. The two groups were comparable with regard to age, parity and gestational age. There was no statistical difference between the two groups in success rate during the 48 h study period (93% for PGE2 versus 97% for PGF2 alpha) or in the average induction-to-abortion interval (16.8 h for PGE2 versus 16.6 h for PGF2 alpha). The frequency of completed abortions was statistically significantly higher and the gastrointestinal side-effects significantly lower in the PGE2-treated patients as compared to the PGF2 alpha-treated subjects. Further, there were fewer complications and the pethidine consumption in women treated with intracervical PGE2 was lower as compared to patients treated with intraamniotic PGF2 alpha. In conclusion, an intracervical PGE2 gel is found applicable and more advantageous than intraamniotic PGF2 alpha in midtrimester abortion. It is safe, convenient and equally easy to administer during the early and the later parts of the second trimester.

Prophylaxis with lymecycline in induced first-trimester abortion: a clinical, controlled trial assessing the role of Chlamydia trachomatis and Mycoplasma hominis.

A clinical, controlled trial was performed to study the effect of prophylaxis with lymecycline and the role of Chlamydia trachomatis and Mycoplasma hominis in postabortal genital infection. Of 532 women who were to undergo first-trimester abortion, 269 were randomized to treatment with oral lymecycline (300 mg bid) starting 2 days before the abortion and continuing for a total of 7 days, and 263 were randomized to placebo treatment. The rate of postabortal infection was 9.3% in the antibiotic group and 9.5% in the placebo group, an insignificant difference (P greater than .8). The presence of C. trachomatis in the cervix/urethra at the time of abortion showed a significant association with the occurrence of postabortal infection (P less than .005), but there was no correlation between the effect of treatment and the presence of infection (P greater than .4). The presence of M. hominis, a history of pelvic inflammatory disease, maternal age, gestational age, the number of births, spontaneous and induced abortion, and the Hegar number showed no significant association with postabortal infection (all P values greater than .05). It is recommended that women who are to undergo induced abortion be examined for the presence of C. trachomatis and treated, as they constitute a risk group.

PIP: A clinical, controlled trial was performed to study the effect of prophylaxis with lymecycline and the role of Chlamydia trachomatis and Mycoplasma hominis in postabortal genital infection. Of 532 women who were to undergo 1st trimester abortion, 269 were randomized to treatment with oral lymecycline (300 mg bid) starting 2 days before the abortion and continuing for a total of 7 days, and 263 were randomized to placebo treatment. The rate of postabortal infection was 9.3% in the antibiotic group and 9.5% in the placebo group, an insignificant difference (P greater than .8). The presence of C. trachomatis in the cervix/urethra at the time of abortion showed a significant association with the occurrence of postabortal infection (P less than .005), but there was no correlation between the effect of treatment and the presence of infection (P greater than .4). The presence of M. hominis, a history of pelvic inflammatory disease, maternal age, gestational age, the number of births, spontaneous and induced abortion, and the Hegar number showed no significant association with postabortal infection (all P values greater than .05). It is recommended that women who are to undergo induced abortion be examined for the presence of C. trachomatis and treated, as they constitute a risk group.

Metronidazole prophylaxis in elective first trimester abortion.

In a double-blind controlled trial, the efficacy of prophylactic metronidazole in elective first trimester abortions was assessed. Of 119 randomized women, 100 followed the protocol. Fifty-one women received 400 mg metronidazole one hour before and again four and eight hours after abortion; 49 women received a placebo. In the placebo group 20.4% contracted postabortal genital infection compared with 3.9% in the metronidazole group (P less than .025). Of 25 women with a positive history of pelvic inflammatory disease, six contracted postabortal infection, which was a significantly increased frequency compared with women without previous episodes of pelvic inflammatory disease (P less than .05). The administration of prophylaxis, however, did not significantly influence the frequency. The number of hospital days was not significantly lower in the prophylaxis group (P greater than .05). The total amount of metronidazole prescribed in the study group was significantly larger than in the placebo group (P less than .05), whereas the amount of ampicillin/pivampicillin prescribed in the placebo group was significantly larger (P less than .05). The difference between the penicillin doses given in the treatment and placebo groups was not significant (P greater than .1).

Peroperative penicillins, bacteremia, and pelvic inflammatory disease in association with induced first-trimester abortion.

In a clinical, controlled trial including 474 women, 250 were randomised to prophylactic treatment with penicillin/pivampicillin and 224 to placebo treatment. Cervical, uterine, and blood cultures were obtained at abortion. In the treatment group, 13 percent developed bacteremia versus 14 percent in the placebo group. The distribution of species cultured from the cervix and uterus was not significantly different from that of the species recovered in the blood. A previous report found that women with a history of pelvic inflammatory disease (PID) carried a higher risk of contracting postabortal genital infection. However, the frequency of bacteremia in these women was not significantly different from the frequency in women without previous PID (p greater than 0.3). In women with and without postabortal infection, no significant differences were observed between the frequencies of bacteremia, either in the antibiotic group (p greater than 0.9) or in the placebo group (p greater than 0.7), suggesting that the release of bacteria into the blood stream from the instrumented tissues is without pathogenetic importance in postabortal infection.