***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: In a single-blind r and omized study , the efficacy of a single intravenous dose of sulbactam ( 0.5 g ) plus ampicillin ( 1 g ) was compared with that of placebo in the prophylaxis of  early postoperative endometritis after abortion with vacuum aspiration in the first trimester . Administration of either sulbactam/ampicillin or placebo occurred immediately before the operation . The two treatment groups were equally matched with respect to patient 's age , gestational age , presence of an intrauterine device , and baseline bacteriologic findings . During the first seven postoperative days , four of 145 patients who had received sulbactam/ampicillin  and 11 of 140 patients who had received placebo  were diagnosed as having endometritis . No adverse effects and no laboratory test abnormalities attributable to treatment were reported in either group . A single dose of sulbactam/ampicillin reduced the incidence of early postoperative endometritis after abortion with vacuum aspiration in the first trimester In a prospect i ve study , 288 women were tested for Chlamydia trachomatis ( CT ) in the cervix prior to legal abortion . In the control group ( n = 259 ) , CT culturing was carried out only when postoperative infection was suspected . CT was isolated in 14.2 % of asymptomatic women . These patients were treated preoperatively with Doxycyc‐line . In this group , no cases of postoperative infection were detected . Among those cases where CT was not detected , 4.9 % contracted the infection , while in the control group the rate of infection was 9.7 % . In the control group all the infections due to CT gave late symptoms after the operation ( 1–4 weeks ) One known complication of induced abortion is upper genital tract infection , which is relatively uncommon in the current era of safe , legal abortion . Currently , rates of upper genital tract infection in the setting of legal induced abortion in the United States are generally less than 1 % . R and omized controlled trials support the use of prophylactic antibiotics for surgical abortion in the first trimester . For medical abortion , treatment-dose antibiotics may lower the risk of serious infection . However , the number-needed-to-treat is high . Consequently , the balance of risk and benefits warrants further investigation . Perioperative oral doxycycline given up to 12 h before a surgical abortion appears to effectively reduce infectious risk .  Antibiotics that are continued after the procedure for extended duration s meet the definition for a treatment regimen rather than a prophylactic regimen . Prophylactic efficacy of antibiotics begun after abortion has not been demonstrated in controlled trials . Thus , the current evidence supports pre-procedure but not post-procedure antibiotics for the purpose of prophylaxis . No controlled studies have examined the efficacy of antibiotic prophylaxis for induced surgical abortion beyond 15 weeks of gestation . The risk of infection is not altered when an intrauterine device is inserted immediately post-procedure . The presence of Chlamydia trachomatis , Neisseria gonorrhoeae or acute cervicitis carries a significant risk of upper genital tract infection ; this risk is significantly reduced with antibiotic prophylaxis . Women with bacterial vaginosis ( BV ) also have an elevated risk of post-procedural infection as compared with women without BV ; however , additional prophylactic antibiotics for women with known BV has not been shown to reduce their risk further than with use of typical pre-procedure antibiotic prophylaxis . Accordingly , evidence to support pre-procedure screening for BV is lacking . Neither povidone-iodine nor chlorhexidine have been shown to alter the risk of infection when used as cervicovaginal preparation . However , chlorhexidine appears to be more effective than povidone iodine at reducing bacteria within the vagina . The Society of Family Planning recommends the routine use of antibiotic prophylaxis , preferably with doxycycline , before surgical abortion . Use of treatment doses of antibiotics with medical abortion may decrease the rare risk of serious infection but universal requirement for such treatment has not been established A clinical , controlled trial was performed to study the effect of prophylaxis with lymecycline and the role of Chlamydia trachomatis and Mycoplasma hominis in postabortal genital infection . Of 532 women who were to undergo first-trimester abortion , 269 were r and omized to treatment with oral lymecycline ( 300 mg bid ) starting 2 days before the abortion and continuing for a total of 7 days , and 263 were r and omized to placebo treatment . The rate of postabortal infection was 9.3 % in the antibiotic group and 9.5 % in the placebo group , an insignificant difference ( P greater than .8 ) . The presence of C. trachomatis in the cervix/urethra at the time of abortion showed a significant association with the occurrence of postabortal infection ( P less than .005 ) , but there was no correlation between the effect of treatment and the presence of infection ( P greater than .4 ) . The presence of M. hominis , a history of pelvic inflammatory disease , maternal age , gestational age , the number of births , spontaneous and induced abortion , and the Hegar number showed no significant association with postabortal infection ( all P values greater than .05 ) . It is recommended that women who are to undergo induced abortion be examined for the presence of C. trachomatis and treated , as they constitute a risk group 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 ) In a clinical , controlled trial including 474 women , 250 were r and omised to prophylactic treatment with penicillin/pivampicillin and 224 to placebo treatment .  Cervical , uterine , and blood cultures were obtained at abortion . In the treatment group , 13 percent developed bacteremia versus 14 percent in the placebo group . The distribution of species cultured from the cervix and uterus was not significantly different from that of the species recovered in the blood . A previous report found that women with a history of pelvic inflammatory disease ( PID ) carried a higher risk of contracting postabortal genital infection . However , the frequency of bacteremia in these women was not significantly different from the frequency in women without previous PID ( p greater than 0.3 ) . In women with and without postabortal infection , no significant differences were observed between the frequencies of bacteremia , either in the antibiotic group ( p greater than 0.9 ) or in the placebo group ( p greater than 0.7 ) , suggesting that the release of bacteria into the blood stream from the instrumented tissues is without pathogenetic importance in postabortal infection A prospect i ve , r and omized study was conducted in 113 women to evaluate the effect of  antibiotic prophylaxis with cefotetan versus no prophylaxis in the prevention of  post-partum and post-abortion sepsis .  The administration of a single 2 g dose of cefotetan at the time of surgery significantly reduced the number of infectious complications , removal of the placenta or an internal inspection were carried out PURPOSE Clinical innovations have made it more feasible to incorporate early abortion into family medicine , yet the outcomes of early abortion procedures in this setting have not been well studied . We wished to assess the outcomes of first-trimester medication and aspiration abortion procedures by family physicians . METHODS Prospect i ve observational cohort study conducted from August 2001 to February 2005 of 2,550 women who sought pregnancy termination in 4 clinical practice s of family medicine departments and 1 private office/training site . RESULTS The rate of successful uncomplicated procedures for medication was 96.5 % ( 95 % confidence interval [ CI ] , 95.5%–97.0 % ) and for aspiration was 99.9 % ( CI , 99.3%–1 ) . Adverse events and complications of medication abortions were failed procedure ( ongoing pregnancy ; n = 19 , 1.45 % ) ; incomplete abortion ( n = 16 , 1.22 % ) ; hemorrhage ( n = 9 , 0.69 % ) ; and patient request for aspiration ( n = 1 , 0.08 % ) . One ( 0.08 % ) missed ectopic pregnancy was seen among patients receiving medication . Four types of adverse outcomes were encountered with aspiration : incomplete abortion requiring re-aspiration ( n = 21 , 1.83 % ) ; hemorrhage during the procedure ( n = 4 , 0.35 % ) ; missed ectopic pregnancy ( n = 3 , 0.26 % ) ; and minor endometritis ( n = 1 , 0.09 % ) . Missed ectopic pregnancies were successfully treated in the inpatient setting without mortality ( overall hospitalization rate of 0.16 of 100 ) . All other complications were managed within outpatient family medicine sites . Rates of complication did not vary by experience of physician or by site of care ( residency vs private practice ) . CONCLUSIONS Complications of medication and aspiration procedures occurred at a low rate , and most were minor and managed without incident Background . Bacterial vaginosis ( BV ) and intermediate flora is known risk‐factor for postoperative infection after surgical termination of pregnancy . Vaginal application of 2 % clindamycin cream is an efficacious treatment for BV , but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post‐abortion infection after surgical termination of pregnancy 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 In a double‐blind stratificated , placebo controlled study the efficacy and safety of a single oral dose of ofloxanin ( Tarivid ) ( 400 mg ) in preventing  postabortal pelvic inflammatory disease ( P‐PID ) in women with induced first‐trimester abortions were assessed . The tablets were given 11/2‐2 h before the abortion , and the women were followed one month after the operation . Group I consisted of 308 with previous PID .  Ofloxacin tablets were given to 149 women and 159 women received placebo tablets . In the ofloxacin group 20 women ( 13.4 % ) and in the placebo group 27 women ( 17 % ) developed P‐PID , a non‐significant difference ( p = 0.39 ) . Group II consisted of 765 women without a history of PID .  Ofloxacin tablets were given to 376 women and 389 women received placebo tablets . Thirty‐five women ( 9.3 % ) in the ofloxacin group and 46 women ( 11.9 % ) in the placebo group developed PID , a nonsignificant difference ( p = 0.26 ) . A single oral dose of ofloxacin ( 400 mg ) did not reduce the incidence of P‐PID either among women with previous PID or among women without previous PID OBJECTIVE To evaluate the occurrence of severe maternal complications associated with  abortion in Brazil . METHODS In a cross-sectional multicenter study , prospect i ve surveillance was done for cases of potentially life-threatening conditions ( PLTC ) , maternal near miss ( MNM ) , and maternal death ( MD ) among 9555 women with obstetric complications between June 2009 and May 2010 .  Abortion was evaluated as a cause , and sociodemographic and obstetric characteristics , safety conditions where the abortion was performed , and the medical procedures used were also assessed . Prevalence ratios adjusted for the cluster effect of the design were calculated with 95 % confidence intervals . Multiple logistic regression analysis was performed to identify factors independently associated with greater severity . RESULTS For 237 women ( 2.5 % ) , abortion result ed in severe complications including PLTC ( 81.9 % ) , MNM ( 15.2 % ) , and MD ( 3 % 
    Output:
    
Antibiotic prophylaxis at the time of first trimester surgical abortion is effective in preventing post-abortal upper genital tract infection .
Evidence of between trial heterogeneity suggests that the effect might not apply to all setting s , population groups or interventions .This review did not determine the most effective antibiotic prophylaxis regimen .