Surgical termination of pregnancy
Before surgical termination of pregnancy, investigate patients for bacterial vaginosis as well as STIs. If the results of investigations are positive, provide appropriate treatment for the STI to reduce the risk of postprocedural infective complications; ideally, treatment should be completed before the procedure.
Surgical antibiotic prophylaxis is not required if the patient has been investigated, and treated as indicated, for bacterial vaginosis and STIs before the procedure.
For prophylaxis for patients who have not been appropriately investigated before surgical termination of pregnancy, use:
1 doxycycline 100 mg orally, 60 minutes before the procedure, then 200 mg orally, 90 minutes after the procedure1 surgical prophylaxis, surgical termination of pregnancy doxycycline
OR
1 doxycycline 400 mg orally, with food, 10 to 12 hours before the procedure2. doxycycline
An alternative regimen is:
metronidazole 2 g orally, within the 120 minutes before the procedure3 surgical prophylaxis, surgical termination of pregnancy metronidazole
PLUS for patients at a higher risk of infection (as below)
azithromycin 1 g orally, within the 120 minutes before the procedure. surgical prophylaxis, surgical termination of pregnancy azithromycin
Women are at a higher risk of post-termination infection, and require adjunctive azithromycin if a metronidazole-based regimen is used, if they meet any of the following criteria:
- age 20 years or younger
- three or more sexual partners in the past 12 months
- a history of pelvic inflammatory disease or an STI in the past 10 years
- clinical evidence of cervicitis
- a sexual partner who has other partners, a history of STI, or current or recent STI symptoms.
Some centres use a single preoperative dose of azithromycin (as monotherapy) for prophylaxis for surgical termination of pregnancy; there are few published data on this approach.