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Antibióticos para el aborto incompleto

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Referencias

Referencias de los estudios incluidos en esta revisión

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Seeras 1989 {published data only}

Seeras R, Evaluation of prophylactic use of tetracycline after evacuation in abortion in Harare Central Hospital. Seeras R , Evaluation of prophylactic use of tetracycline after evacuation in abortion in Harare Central Hospital. East Afr Med J 1989;66(9):607‐10.

Referencias de los estudios excluidos de esta revisión

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Brewer 1980 {published data only}

Brewer C. Prevention of infection after abortion with a supervised single dose of oral doxycycline. Brit Med J 1980;281:780‐781.

Brown 2003 {published data only}

Brown HC, Jewkes R, LevinJ, Dickson‐Tetteh K, Rees H. Management of incomplete abortion in South African public hospitals. BJOG: Int J Obstet Gynaecol 2003;110:371‐377.

Chow 1977 {published data only}

Chow AW, Marshall, JR, Guze LB. A double‐blind comparison of clindamycin with penicillin plus chloramphenicol in treatment of septic abortion. J Infect Dis 1977;135(Suppl):S35‐39.

Crowley 2001 {published data only}

Crowley T, Low N, Turner A, Harvey I, Bidgood K, Horner P. Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial. Br J Obstet Gynaecol 2001;108:396‐402.

Darj 1987 {published data only}

Darj E, Stralin EB, Nilsson S. The prophylactic effect of doxycycline on postoperative infection rate after first‐trimester abortion. Obstet Gynecol 1987;70(5):755‐758.

Foy 2004 {published data only}

Foy R, Penney GC, Grimshaw JM, Ramsay CR, Walker AE, MacLennan G, Stearns SC, McKenzie L, Glasier A. A randomised controlled trial of a tailored multifaceted strategy to promote implementation of a clinical guideline on induced abortion care. BJOG: Int J Obstet Gynaecol 2004;111:726‐733.

Gebreselassie 2005 {published data only}

Gebreselassie H, Gallo MF, Monyo A, Johnson BR. The magnitude of abortion complications in Kenya. BJOG: Int J Obstet Gynaecol 2005;112:1229‐1235.

Heisterberg 1986 {published data only}

Heisterberg L, Petersen K, Sorensen SS, Nielsen D. A comparison of metronidazole and ampicillin prophylaxis to women with a history of pelvic inflammatory disease undergoing first‐trimester abortion. Int J Gynaecol Obstet 1986;24:343‐346.

Henriques 1994 {published data only}

Henriques CU, Wilken‐Jensen C, Thorsen P, Moller BR. A randomised controlled trial of prophylaxis of post‐abortal infection: ceftriaxone versus placebo. Brit J Obstet Gynaecol 1994;101(7):610‐614.

Hodgson 1975 {published data only}

Hodgson JE, Major B, Portmann K, Quattlebaum FW. Prophylactic use of tetracycline for first trimester abortions. Obstet Gynecol 1975;45(5):574‐578.

Levallois 1988 {published data only}

Levallois P, Rioux JE. Prophylactic antibiotics for suction curettage abortion: Results of a clinical controlled trial. Am J Obstet Gynecol 1988;158(1):100‐105.

Lichtenberg 2003 {published data only}

Lichtenberg ES, Shott S. A randomized clinical trial of prophylaxis for vacuum abortion: 3 versus 7 days of doxycycline. Obstet Gynecol 2003;101:726‐731.

Miller 2004 {published data only}

Miller L, Thomas K, Hughes JP, Holmes KK, Stout S, Eschenbach DA. Randomised treatment trial of bacterial vaginosis to prevent post‐abortion complication. BJOG: Int J Obstet Gynaecol 2004;111:982‐988.

Penney 1998 {published data only}

Penney GC, Thomson M, Norman C, McKenzie H, Vale L, Smith R, Imrie M. A randomised comparison of strategies for reducing infective complications of induced abortion. Brit J Obstet Gynaecol 1998;105(6):599‐604.

Prieto 1995 {published data only}

Prieto JA, Eriksen, NL, Blanco JD. A randomized trial of prophylactic doxycycline for curettage in incomplete abortion. Obstet Gynaecol 1995;85:692‐696.

Reeves 2005 {published data only}

Reeves MF, Smith, KJ, Creinin MD. The cost‐effectiveness of antibiotic use at surgical abortion: comparing prophylactic to treatment regimens. Contraception 2005;72:242‐243.

Sonne‐Holm 1981 {published data only}

Sonne‐Holm S, Heisterberg L, Hebjorn S, Dyring‐Andersen K, Andersen JT, Hejl BL. Prophylactic antibiotics in first‐trimester abortions: A clinical controlled trial. Am J Obstet Gynecol 1981;139(6):693‐696.

Spence 1982 {published data only}

Spence MR, King TM, Burkman RT, Atienza MF. Cephalothin prophylaxis for midtrimester abortion. Obstet Gynecol 1982;60(4):502‐505.

Referencias adicionales

Ir a:

Billings 1998

Billings DL. Training Midwives to Improve Postabortion Care: A study tour in Ghana, October 12‐19, 1997. Ipas. Republic of Ghana. Ghana Registered Midwives Association 1998.

Blackwell 1993

Blackwell AL, Thomas PD, Wareham K, Emergy SJ. Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Lancet 1993;342:206‐210.

Chow 1977

Chow AW, Marshall JR, Guze LB. A double‐blind comparison of clindamycin with penicillin plus chloramphenicol in treatment of septic abortion. J Infect Dis 1977;135(Suppl):S35‐39.

Darj 1987

Darj E, Stralin EB Nilsson S. The prophylactic effect of doxycycline on postoperative infection rate after first‐trimester abortion. Obstet Gynecol 1987;70:755‐759.

Ekwempu 1990

Ekwempu CC. Uterine aspiration using the Karman cannula and syringe. Trop J Obst Gynaecol 1990;8N2:37‐38.

Fawcus 1997

Fawcus S, McIntyre J, Jewkes RK, Rees H, Katzenellenbogen JM, Shabodien R, et al. Management of incomplete abortions at South African public hospitals. National Incomplete Abortion Study Reference Group. S Afr Med J 1997;1(4):438‐442.

Greenslade 1993

Greenslade FC, Leonard AH, Benson J, Winkler J, Henderson VL. Manual vacuum aspiration: A summary of clinical and programmatic experience worldwide. Carrboro, North Carolina, Ipas. journal 1993;1:1 onwards.

Grimes 1984

Grimes DA, Schulz KF, Cates WJ. Prophylactic antibiotics for curettage abortion. Am J Obstet Gynecol 1984;150:689‐694.

Heisterberg 1987

Heisterberg L. Prophylactic antibiotics in women with a history of pelvic inflammatory disease undergoing first‐trimester abortion. Acta Obstet Gynecol Scand 1987;66:15‐18.

Hemsell 1991

Hemsell DL. Prophylactic antibiotics in gynaecologic and obstetric surgery. Rev Infect Dis 1991;13:821‐841.

Henshaw 1990

Henshaw SK, Morrow E. Induced Abortion: A World Review, The Alan Guttmacher Institute. Review1990; Vol. Suppl.

Jewkes 1997

Jewkes RK, Fawcus S, Rees H, Lombard CJ, Katzenellenbogen J. Methodological issues in the South African Incomplete Abortion study. Studies in Family Planning, 1997;28:228‐234.

Kizza 1990

Kizza APM, Rogo KO. Assessment of the manual vacuum aspiration (MVA) equipment in the management of incomplete abortion. East Afr Med J 1990;67(11):812‐821.

Popov 1991

Popov AA. Family planning and induced abortion in the USSR: Basic health and demographic characteristics. Studies Fam Plan 1991;22:368‐377.

Population Rep. 1997

Population Reports. Care for Postabortion Complications: Saving Women's Lives, Population Information Program, Center for Communication Programs,. The Johns Hopkins School of Public Health, Maryland, USA1997; Vol. XXV.

Prieto 1995

Prieto JA, Eriksen NL, Blanco JD. A randomized trail of prophylactic doxycycline for curettage in incomplete abortion. Obstet Gynaecol 1995;85:692‐696.

Rees 1997

Rees H, Katzenellenbogen J, Shabodien R, Jewkes R, Lombard C, Truter H and the National Incomplete Abortion Reference Group. The epidemiology of incomplete abortion in South Africa. S Afr Med J, 1997;87:432‐437.

Sawaya 1996

Sawaya GF, Grady D, Kerlikowske K, Grimes D. Antibiotics at the time of induced abortion. The case for universal prophylaxis based on a meta‐analysis. Obstet Gynecol 1996;87:884‐890.

Sonne‐Holm 1981

Sonne‐Holm S, Heisterberg L, Hebjorn S, Dyring AK, Andersen JT, Hejl BL. Prophylactic antibiotics in first trimester abortions: A clinical, controlled trial. Am J Obstet Gynecol 1981;139:693‐696.

Verkuyl 1993

Verkuyl DAA, Crowther CA. Suction v. conventional curettage in incomplete abortion ‐ A randomised controlled trial. S Afr Med J 1993;83:13‐15.

WHO 1994

World Health Organization, Geneva. Abortion: A Tabulation of Available Data on the Frequency and Mortality of Unsafe abortion. 2nd edition, WHO Division of Family Health, Maternal Health and Safe motherhood Programme1994.

WHO 1995

World Health Organization, Geneva. Complications of abortion: Technical and managerial guidelines for prevention and treatment. Guidelines1995.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Seeras 1989

Methods

Randomised into two groups using sealed envelopes containing the treatment modality.

Participants

140 women admitted with a diagnosis of incomplete abortion to a tertiary care hospital inHarare, Zimbabwe. Included women with clinical evidence of an incomplete abortion; oral temperature not higher than 37°C; absence of a foul‐smelling vaginal discharge; absence of abdominal tenderness, and a negative cervical excitation test

Interventions

Experimental: Tetracycline 500 mg four times daily for one week and evacuation
Control: Evacuation

Outcomes

Postabortal sepsis based on the presence of at least 3 out of 5 parameters: 1) history of chills, fever, headache,or lower abdominal pain; 2) oral temperature of greater than 37°C; 3) abdominal tenderness; 4) positive cervical excitation test; 5) presence of a foul smelling vaginal discharge.

Notes

Post‐experimental exclusions: None reported
Loss to follow‐up: 2 in EXPT and 3 in CNTRL
On follow‐up after one week, compliance was found to be very low. 82.6% had either not taken part of the whole course or the whole course. the 17.6% who did, failed to follow the instructions properly.
The evacuation method was not mentioned.
The author recommended the use of Doxycycline or any other antibiotic which is cheap and covers a wide range of organisms, administered as a single dose.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment

Low risk

A ‐ Adequate

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Brewer 1980

The study was excluded since it was on women undergoing induced abortion

Brown 2003

Descriptive study ‐ not RCT

Chow 1977

The study was on women with septic abortion.

Crowley 2001

Randomised double‐blind placebo‐controlled trial, but for women with bacterial vaginosis for induced abortion

Darj 1987

The study was excluded since it was on women undergoing induced abortion.

Foy 2004

Cluster RCT for induced abortion , not for incomplete abortion

Gebreselassie 2005

Descriptive study on magnitude of abortion complications in Kenya

Heisterberg 1986

The study was excluded since it was on women with a history of pelvic inflammatory disease undergoing first‐trimester abortion.

Henriques 1994

Excluded since the study was on women admitted for legal termination of pregnancy at 12 weeks or less of gestation.

Hodgson 1975

The study was excluded since it was on patients undergoing first trimester abortions.

Levallois 1988

The study was excluded since it was on women who were seeking induced abortions.

Lichtenberg 2003

RCT but for surgical abortion, not for incomplete abortion

Miller 2004

Randomised trial, but on women with bacterial vaginosis

Penney 1998

Study excluded because it was on women undergoing induced abortion

Prieto 1995

This study had a high allocation concealment quality score (A); the generation of allocation sequence was reported and adequate; power calculation was done; and blinding of outcome assessment was presumably but not specifically done. There was no blinding of providers nor patients. However, the randomization schedule for each patient was not known by the examining physician at the time of the 2‐week follow‐up pelvic examination. Post‐experimental exclusions and protocol deviation was not reported. However, there was a loss to follow‐up of 30.5% which was 0.5% higher than the 30% which the reviewers had specified for the exclusion criteria, which was the reason for exclusion of the study.

The study was conducted on 345 consenting women with an estimated gestational age of 6 ‐ 14 weeks with an incomplete abortion at a tertiary care hospital in Texas, U.S.A. Exclusion criteria were: haemodynamically unstable; allergic to doxycline; had evidence of a septic abortion or urinary tract or pelvic infection.

Interventions were Doxycycline 100 mg intravenously and suction curettage for the experimental group and normal saline and suction curettage for the control group. Follow up was after 2‐3 weeks. Outcome assessed was infectious morbidity which was diagnosed if any two or more of the following symptoms were found: 1) low abdominal pain; 2) uterine, adnexal or cervical motion tenderness; 3) purulent leukorrhoea; 4) leukocytosis of more than 15,000/cu. mm.; or 5) fever above 100.4°F.

The authors concluded that in their population of patients with incomplete abortion, prophylactic doxycycline did not decrease the rate of postoperative febrlle morbidity.

This study was methodologically sound and the trial was done according to the protocol. If it had not been for the loss to follow‐up which exceeded the reviewers' criteria by 0.5%, it would have been included.

Reeves 2005

Cost‐effective analysis ‐ not RCT

Sonne‐Holm 1981

The study was excluded since it was on women having induced first‐trimester abortions.

Spence 1982

The study was excluded since it was on women undergoing second trimester intraamniotic injection abortions.

Data and analyses

Open in table viewer
Comparison 1. Any antibiotic vs nothing

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 postabortion infection Show forest plot

1

135

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.61 [0.79, 3.26]
Analysis 1.1
Comparison 1 Any antibiotic vs nothing, Outcome 1 postabortion infection.

Comparison 1 Any antibiotic vs nothing, Outcome 1 postabortion infection.

Comparison 1 Any antibiotic vs nothing, Outcome 1 postabortion infection.
Figuras y tablas -
Analysis 1.1

Comparison 1 Any antibiotic vs nothing, Outcome 1 postabortion infection.

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Comparison 1. Any antibiotic vs nothing

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 postabortion infection Show forest plot

1

135

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.61 [0.79, 3.26]
Figuras y tablas -
Comparison 1. Any antibiotic vs nothing
Ir a la tabla de la revisión