Penney G C, Thomson M, Norman J, McKenzie H, Vale L, Smith R, Imrie M
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital.
Br J Obstet Gynaecol. 1998 Jun;105(6):599-604. doi: 10.1111/j.1471-0528.1998.tb10173.x.
To determine lower genital tract carriage rates of C. trachomatis, N. gonorrhoeae and bacterial vaginosis among women seeking termination of pregnancy. To compare two clinical management strategies for minimising the risks of infective morbidity after induced abortion.
Prevalence of infections was assessed by screening women undergoing abortion. Clinical management strategies were compared by a randomised trial.
The gynaecology departments of four hospitals in Scotland.
1672 women undergoing induced abortion.
Women randomised to prophylaxis received metronidazole 1 g rectally before abortion plus doxycycline 100 mg twice daily for seven days. Women randomised to screen-and-treat received appropriate antibiotics only if screening proved positive for one or more infection.
Prevalences of infections; morbidity in the eight weeks following abortion as assessed by reported symptoms, general practitioner consultation and prescription rates and hospital re-attendances; costs to the NHS of alternative managements.
Prevalence rates: 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 screen-and-treat. These differences only reached statistical significance for women who were reported negative on screening. The direct costs to the NHS of prophylaxis and screen-and-treat were calculated to be 8.17 and 18.34 per woman, respectively.
Prevalences of lower genital tract infections which have been implicated in increased rates of infective morbidity after abortion are similar to those reported elsewhere. Universal antibiotic prophylaxis is at least as effective as a policy of screen-and-treat in minimising the risk of short term infective morbidity and is far more cost efficient.
确定寻求终止妊娠的女性下生殖道沙眼衣原体、淋病奈瑟菌及细菌性阴道病的携带率。比较两种临床管理策略，以降低人工流产后感染性发病的风险。
通过对接受流产的女性进行筛查来评估感染的患病率。通过随机试验比较临床管理策略。
苏格兰四家医院的妇科。
1672名接受人工流产的女性。
随机分配接受预防治疗的女性在流产前直肠给予1g甲硝唑，外加每日两次口服100mg强力霉素，共七天。随机分配接受筛查和治疗的女性仅在筛查证明一种或多种感染呈阳性时才接受适当的抗生素治疗。
感染患病率；流产后八周内的发病率，通过报告的症状、全科医生会诊和处方率以及再次入院情况进行评估；国民健康服务体系（NHS）对不同管理方式的成本。
患病率：沙眼衣原体5.6%；淋病奈瑟菌0.19%；细菌性阴道病17.5%。总体而言，被分配接受预防治疗的女性短期感染性发病指标的发生率低于被分配接受筛查和治疗的女性。这些差异仅在筛查报告为阴性的女性中具有统计学意义。预防治疗和筛查及治疗对NHS的直接成本分别计算为每位女性8.17和18.34。
与流产后感染性发病率增加有关的下生殖道感染患病率与其他地方报告的相似。在将短期感染性发病风险降至最低方面，普遍使用抗生素预防至少与筛查和治疗策略一样有效，且成本效益更高。
