Preventing infective sequelae of abortion

Area of Science:

• Reproductive Health
• Infectious Diseases
• Public Health

Background:

• Pelvic infection affects up to 12% of induced abortions, impacting future reproductive outcomes.
• Lower genital tract infections (Neisseria gonorrhoeae, Chlamydia trachomatis, bacterial vaginosis) increase post-abortion infective morbidity.
• Antibiotic prophylaxis against C. trachomatis or bacterial vaginosis halves this risk.

Purpose of the Study:

• To determine the prevalence of genital tract infections in Scottish women undergoing induced abortion.
• To compare the effectiveness and cost-effectiveness of 'universal prophylaxis' versus 'screen and treat' strategies for minimizing infective morbidity.

Main Methods:

• A multicentre study involving 1672 women seeking induced abortion.
• Comparison of infective morbidity rates between women receiving universal antibiotic prophylaxis and those undergoing screening and targeted treatment.
• Prevalence assessment of Neisseria gonorrhoeae, Chlamydia trachomatis, and bacterial vaginosis.

Main Results:

• Prevalence rates of key infections were comparable to other UK studies.
• The 'screen and treat' strategy resulted in slightly higher infective morbidity rates within 8 weeks post-abortion compared to 'prophylaxis'.
• Universal prophylaxis was found to be more cost-effective given current screening tests and services.

Conclusions:

• Universal antibiotic prophylaxis is a more effective strategy than 'screen and treat' for reducing infective morbidity after induced abortion.
• 'Prophylaxis' demonstrates better cost-effectiveness in managing post-abortion complications.
• Findings support the use of antibiotic prophylaxis to improve reproductive health outcomes following induced abortions.