***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To describe the epidemiology of  incomplete abortion ( spontaneous miscarriage and illegally induced ) in South Africa . DESIGN Multicentre , prospect i ve , descriptive study . SETTING Fifty-six public hospitals in nine provinces ( a stratified , r and om sample of all hospitals treating gynaecological emergencies ) . PATIENTS All women of gestation under 22 weeks who presented with incomplete abortion during the 2-week study period . MAIN OUTCOME MEASURES Incidence of , morbidity associated with and mortality from incomplete abortion . MAIN RESULTS An estimated 44686 ( 95 % CI 35633 - 53709 ) women per year were admitted to South Africa 's public hospitals with  incomplete abortion . An estimated 425 ( 95 % CI 78 - 735 ) women die in public hospitals from complications of abortion . Fifteen per cent ( 95 % CI 13 - 18 ) of patients have severe morbidity while a further 19 % ( 95 % CI 16 - 22 ) have moderate morbidity , as assessed by categories design ed for the study which largely reflect infection . There were marked inter-provincial differences and inter-age group differences in trimester of presentation and proportion of patients with appreciable morbidity . CONCLUSIONS Incomplete abortions and , in particular , unsafe abortions are an important cause of mortality and morbidity in South Africa . The methods used in this study underestimate the true incidence for reasons that are discussed . A high priority should be given to the prevention of unsafe abortion A r and omised controlled trial involving 140 non-septic incomplete abortions was performed to determine the efficacy of prophylactic tetracycline as practice d in these cases in Harare Central Hospital . The treatment group ( 62 ) received tetracycline ( 500 mg four times daily ) for a week . The remainder acted as controls . No significant difference in sepsis rate between treatment and control groups was noted . The high sepsis recorded in the treatment group was thought to be due to poor compliance . A new prophylaxis regimen has been suggested In a double‐blind controlled trial the effect of prophylactic metronidazole on  postabortal infection in women with a history of pelvic inflammatory disease ( PID ) was assessed . One hundred and thirty‐five women were eligible for r and omization , of whom 17 were excluded . The regimen consisted of oral metronidazole 400 mg 1 h before the abortion and again 4 and 8 h after , or else placebo . In the placebo group the rate of postabortal PID was 13.0 % ( 7/54 ) and in the metronidazole group 10.9 % ( 7/64 ) , a nonsignificant difference ( p>0.7 ) . Women in gestational weeks 11−12 had a significantly increased rate of postabortal PID compared with women in weeks 6–10 ( p<0.005 ) , but this rate was not influenced by the treatment ( p>0.2 ) . Women with parity 1 had a significantly increased rate of postabortal PID compared with women with parity 0 ( p<0.05 ) , but again the treatment did not influence this rate significantly ( p>0.2 ) . The number of hospital days for women in the metronidazole group did not differ significantly from that in the placebo group ( p<0.1 ) . The amount of metronidazole  administered for prophylactic and postabortal treatment was significantly greater in the metronidazole group ( p<0.001 ) . The amounts of other antibiotics prescribed showed non‐significant differences between the two groups ( all p‐values > 0.3 ) This r and omised controlled trial of 357 patients who had had an incomplete abortion compared suction curettage with conventional curettage for evacuation of the uterus . The 179 patients undergoing suction curettage had a significantly lower intra-operative blood loss ( P < 0.0001 ) and a significantly higher mean haemoglobin level at follow-up compared with the 178 patients who had conventional curettage . Suction curettage was a faster procedure and less painful . No difference was found between the two groups with regard to the incidence of post-abortal sepsis , or the re-evacuation rate . No problems were encountered with the use of  suction curettage  in the presence of uterine sepsis . In an era where blood transfusions should be kept to an absolute minimum , suction curettage will help to save blood in several ways In 1994 , a national hospital-based study was undertaken of cases of incomplete abortion presenting to public hospitals in South Africa . Data were collected for all women admitted to a r and om sample of hospitals with incomplete abortion during a two-week period . The WHO protocol for such studies was used as a basis for developing the methods to describe the epidemiology of incomplete abortion and hospital management of cases . Attempts were made to estimate the proportion of cases that might have been induced . This report focuses on method ological issues arising from the study that have implication s for future research . The findings demonstrate that only a small proportion of the women acknowledged having had an induced abortion and that only a few of those who did showed evidence of interference with pregnancy . Clinical opinion of sepsis and the likelihood of induction were found to be highly unreliable . These findings considerably reduce the usefulness of the WHO- protocol method of estimating the likely origin of incomplete abortions . Results presented in terms of three partially overlapping descriptive categories are judged to better reflect the limitations of the data collected The responses to therapy with either clindamycin alone or penicillin plus chloramphenicol in 77 patients with septic abortions were compared in a r and omized , double-blind study . Although fever index and duration of hospitalization were similar for both groups of patients , significantly more patients in the group that received clindamycin developed major complications ( P less than 0.05 ) . This is believed to result from clindamycin 's lack of activity against aerobic gram-negative bacilli . Aggressive management that included early uterine evacuation and broad-spectrum antibiotics effective against both aerobic and anaerobic bacteria was the key to reduced morbidity and mortality rates in treatment of septic abortion . For patients treated with clindamycin , early uterine evacuation appeared more important than antibiotic therapy ( P less than 0.005 ) . Bacteremia was documented in a total of 29 patients ( 38 % ) . Bacteremia was polymicrobial in eight patients ( 28 % ) and involved anaerobes exclusively in 18 ( 62 % ) , aerobes exclusively in nine ( 31 % ) , and both aerobes and anaerobes in two ( 7 % ) . The organisms most frequently isolated were Bacteroides ( other than Bacteroides fragilis ) , Peptostreptococcus , and Escherichia coli Opinion is divided as to the advisability of routine use of prophylactic antibiotics for curettage abortion . Six studies , including three r and omized clinical trials , suggest that prophylaxis reduces infectious morbidity associated with curettage abortions by about one half . Three other studies , two involving prophylaxis for instillation abortions and one involving a vaginal antiseptic for curettage abortion , support the hypothesis that antimicrobial prophylaxis reduces morbidity .  Tetracyclines are commonly used for this purpose . The cost of routine prophylaxis even with an expensive tetracycline would appear to be offset by the savings in direct and indirect costs . Prophylaxis may help prevent both short-term morbidity and potential late sequelae , such as ectopic pregnancy and infertility Objective To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis OBJECTIVE To estimate prospect ively whether reducing oral doxycycline prophylaxis from 7 to 3 days increases the incidence of endometritis after elective first-trimester vacuum abortion . METHODS We r and omized 800 women requesting first-trimester abortion to two study groups : 1 ) 100 mg of doxycycline administered orally twice a day for 7 days or 2 ) 100 mg of doxycycline orally twice a day for 3 days followed by an oral placebo twice daily for the last 4 days . Doxycycline was prescribed immediately after surgery . RESULTS There were no statistically significant differences in age , race , gravidity , parity , number of previous abortions , current gestational age , and history of previous pelvic infection , chlamydia , or intrauterine device use . Women in the doxycycline plus placebo group were more likely to have had a history of gonorrhea ( 3.3 % versus 0.8 % , P = .42 ) or chlamydia ( 7.0 % versus 4.3 % , P = .18 ) . The 66.3 % of enrollees returning for 2-week examinations were distributed similarly between study groups and were similarly compliant in self-reported pill taking ( mean 97.5 % ) . The study groups did not differ in the incidence of postoperative symptoms or examination findings suggesting infection . One patient in the doxycycline-only group developed endometritis and was treated as an outpatient . CONCLUSION Shortening oral doxycycline prophylaxis from 7 to 3 days had no adverse effect on the incidence of postabortion infection Objective To investigate the incidence of post‐operative infection after first trimester abortion in women treated with a long‐acting cephalosporin ( ceftriaxone )  compared with low risk patients receiving no treatment and with high risk patients receiving our st and ard treatment of ampicillin/pivampicillin and metronidazole complications . Three patients had haemoptysis and two slight epistaxis .  Three patients vomited , including the one in whom the procedure was ab and oned . There were 39 visible tumours . In 29 out of the 38 of these that were examined the histological opinion was definitive . Failure to make a positive diagnosis was associated with necrotic tumour tissue , previous radiotherapy , or a difficult biopsy . Where the appearance was of extrinsic compression a positive diagnosis was possible in only two out of 11 cases . In 11 cases examination showed non-malignant disease The efficacy of prophylactic antibiotic therapy in induced first-trimester abortions was investigated in a double-blind study . Of the 493 women in the study , 254 received doses of 2 million IU of penicillin G intramuscularly one-half hour before and 3 hours after the procedure , followed by 350 mg of pivampicillin three times daily for 4 days , and 239 women received corresponding doses of placebo . The incidence of pelvic infectious complications was 5.5 % in the treated group and 10.9 % in the control group ( p = 0.05 ) . The difference could be attributed to a selective prophylactic effect in women who had earlier suffered from pelvic inflammatory disease ( N = 105 ) . The rate of infection in this group was 22.4 % among those receiving placebo and 2.1 % among those receiving antibiotics ( p = 0.006 ) . Prophylactic administration of antibiotics for first-trimester abortions should be used in women who have earlier had pelvic inflammatory disease A prospect i ve double-blind study was performed to evaluate the effect of  prophylactic antibiotic treatment before induced abortion . Eight hundred consecutive women admitted for first-trimester abortion , without signs of genital infection or antibiotic use in the last three weeks , were included in the study . Doxycycline 400 mg or placebo was given as a single oral dose ten to 12 hours before vacuum aspiration .  Ninety-one women ( 11.8 % ) returned to the hospital with suspected complications . Thirty-two of these women were diagnosed as having pelvic inflammatory disease , eight of whom ( 2.1 % ) had received doxycycline before the abortion and 24 of whom ( 6.2 % ) had received placebo , a statistically significant difference ( P < .01 ) . A history of pelvic inflammatory disease increased the risk of developing it again after an abortion Objective To evaluate the efficacy of metronidazole to reduce post‐abortion complications among women with bacterial vaginosis Objective To evaluate the effectiveness and efficiency of a tailored multifaceted strategy , delivered by a national clinical effectiveness programme , to implement a guideline on induced abortion The prophylactic use of 300 mg doxycycline at the time of an abortion was evaluated in a r and omized controlled trial . In the group with negative chlamydia screening results , only two ( 0.4 % ) of 502 patients who received prophylactic treatment developed pelvic infection , compared with 15 ( 3.0 % ) of 497 patients who received placebos ( p = 0.001 ) . The same effectiveness was found in women with positive chlamydia screening results .  Vomiting was the major side effect of the medication and could limit its use . A simulation of selective prophylaxis in women with negative chlamydia screening results showed that its selective use in patients with a history of gonorrhea or in nulliparous women with multiple sex partners could be nearly two thirds as effective as general prophylaxis A r and omized prospect i ve double-blind study was conducted to determine the efficacy of prophylactic antibiotics as compared with placebo in 198 women undergoing secondtrimester intraamniotic injection abortions . Patients received either sodium cephalothin or placebo intravenously before 
    Output:
    
No differences were detected in postabortal infection rates with routine prophylaxis or control .
However , compliance with antibiotic treatment was also low .
There is not enough evidence to evaluate a policy of routine antibiotic prophylaxis to women with incomplete abortion