Prophylactic use of antibiotic for incomplete and missed miscarriage, prior to medical and surgical management: a randomized controlled trial

Abstract

Introduction: Miscarriage is a common gynaecological problem in day to day practice. Post miscarriage care is a challenging area coming under reproductive health. Prevention of pelvic sepsis is a main component. Effective antibiotic prophylaxis at the time of treatment for incomplete and missed miscarriage may be the answer for it. But in current practice, there is conflicting evidence and no clear guidance for the necessity of antibiotic prophylaxis. Objective: To determine the effectiveness of prophylactic doxycycline use, prior to surgical and medical evacuation of incomplete and missed miscarriage, in view of reducing the post -procedure pelvic infections. Method: Three hundred and ninety four patients were randomized into two groups. One group (n=200) received 200mg doxycycline single dose and the other group (n=194) received placebo single dose, one hour prior to the medical and surgical management. Post procedure pelvic infection was assessed by five clinical parameters within three days and two weeks later. SPSS used for the data analysis. Result: There were no statistically significant differences in the age, parity, number of children and gestational age in between the doxycycline and placebo groups. Post intervention pelvic infection was diagnosed 4% in the doxycycline group and 6.18% in the placebo group within three days, which was not statistically significant (P=0.367). It was 4.5% and 8.7% for doxycycline and placebo treated groups respectively at two weeks. It was also not clinically significant (P=0.104). There was no statistically significant difference in the type of miscarriage or the type of interventions in between the two groups. Conclusion: The study revealed that single dose doxycycline prophylaxis prior to medical and surgical management of miscarriage was not able to achieve a statistically significant reduction in post intervention pelvic infection.