Study reveals new evidence about infection after miscarriage surgery

New international guidelines on how to provide treatment for women having miscarriage surgery are needed after a large-scale international trial has provided new evidence.

The trial, published in the New England Journal of Medicine, involved thousands of women at hospitals across four low- and middle-income countries, including the Aga Khan University Hospital in Karachi and 12 other hospitals across Malawi, Tanzania and Uganda. The findings of the study show that administering antibiotics prior to miscarriage surgery had a possible benefit when pelvic infection was defined by global standards.

“Before the trial, we had no idea what the right thing was, to reduce the serious complication of pelvic infection. We finally now have the highest quality evidence that a single, cheap, preventative dose of two commonly available antibiotics was not only safe but also appeared to reduce pelvic infection if the infection was diagnosed using strict international criteria,” said lead researcher Dr David Lissauer of the University of Birmingham.

Infections following miscarriage surgery are more common in low- and middle-income countries like Pakistan versus higher resource countries.

“In Pakistan, access to resources to care for women who do develop complications after miscarriage surgery is poor. The findings of this study will lead to improved treatment outcomes for women,” said Dr Rahat Qureshi, associate professor, department of obstetrics and gynaecology, at the AKU, and one of the authors of the study, along with Dr Zulfiqar A Bhutta, the founding director of AKU’s Centre of Excellence in Women and Child Health.

“Globally there are concerns about the irrational and widespread use of antibiotics which can fuel antibiotic resistance. This practice is rampant in Pakistan as well – which is why quality processes within our health system must be initiated to prevent infections. In addition, a balanced use of antibiotics will improve practices and reduce the risks of emergence of resistant bacteria,” she added.

Prior to this study, there were only four trials conducted on antibiotic use in women undergoing surgery for miscarriage. These trials were conducted at single centres, used different antibiotics and assessed different outcomes. This study, however, was a multi-country, multi-centre randomised trial, the findings of which will call for a reassessment of international guidelines on the use of antibiotics in miscarriage surgery.

A miscarriage is the most common complication of early pregnancy – the loss of a baby before 20 weeks. However, sometimes not all the residual pregnancy tissue is dispelled through the womb after a miscarriage; so often a surgery is required to remove it. Miscarriage surgery is one of the most common surgical procedures carried out around the world.