Usefulness of Antibiotic Prophylaxis in Miscarriage Surgery for Induced Abortion and Retained Products of Conception: a Narrative Review

Abstract

Background: Miscarriage surgery is one of the most performed surgeries worldwide. Prophylactic antibiotics aim to avoid postoperative pelvic infection. Its use and benefit are well-known in induced surgical abortion, but far more ambiguous for miscarriage surgery for retained products of conception. Objective: To investigate the usefulness of prophylactic antibiotics in miscarriage surgery for retained products of conception and induced abortion and evaluate the antibiotic regimen of preference. Material and Methods: A comprehensive electronic literature search was conducted using PubMed, MEDLINE and Google Scholar. There were no specific inclusion criteria concerning study design, publication year, language, or study population. Results: When evaluating the effectiveness of antibiotic prophylaxis for surgical intervention in induced abortion, 12 out of 19 studies showed a significant reduction on pelvic infection compared to the control group. There was no consensus regarding type and regimen of antibiotics. Five studies investigated prophylaxis in interventions for retained products of conception, of which 2 could show a significant effect. Conclusion: There is evidence that antibiotic prophylaxis reduces the risk of pelvic infection. Single dose preoperatively is favoured, for its effectiveness and patient compliance. Doxycycline and metronidazole are preferred, as for the type of antibiotics. There is limited evidence that antibiotic prophylaxis for surgical removal of retained products of conception or non-viable pregnancies might reduce the risk of pelvic infection.