Do Preoperative Antibiotics Lower Infection Risk Following Surgical Management of Miscarriage?

The American College of Obstetricians and Gynecologists recommends a preoperative antibiotic to prevent postoperative pelvic infection after uterine evacuation for either a miscarriage or a pregnancy termination (Obstet Gynecol 2018; 131:e172). To investigate the clinical utility of this approach, investigators randomized 3412 women undergoing surgery for incomplete spontaneous abortion in Malawi, Pakistan, Tanzania, and Uganda to preoperative oral antibiotics (400 mg doxycycline plus 400 mg metronidazole) or placebo.

In analysis using CDC criteria for pelvic infection (≥2 of the following clinical features: purulent vaginal discharge, fever, pelvic tenderness, or white blood cell count ≥12,000 per µL), antibiotics compared with placebo sign…