***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: OBJECTIVES To determine lower genital tract carriage rates of C. trachomatis , N. gonorrhoeae and bacterial vaginosis among women seeking termination of pregnancy . To compare two clinical management strategies for minimising the risks of infective morbidity after induced abortion . DESIGN Prevalence of infections was assessed by screening women undergoing abortion . Clinical management strategies were compared by a r and omised trial . SETTING The gynaecology departments of four hospitals in Scotl and . PARTICIPANTS 1672 women undergoing induced abortion . INTERVENTIONS Women r and omised to prophylaxis received metronidazole 1 g rectally before abortion plus doxycycline 100 mg twice daily for seven days . Women r and omised to screen- and -treat received appropriate antibiotics only if screening proved positive for one or more infection . MAIN OUTCOME MEASURES Prevalences of infections ; morbidity in the eight weeks following abortion as assessed by reported symptoms , general practitioner consultation and prescription rates and hospital re-attendances ; costs to the NHS of alternative managements . RESULTS Prevalence rates : C. trachomatis 5.6 % ; N gonorrhoeae 0.19 % ; bacterial vaginosis 17.5 % . Overall , women allocated to receive prophylaxis had lower rates of measures of short term infective morbidity than those allocated to screen- and -treat . These differences only reached statistical significance for women who were reported negative on screening . The direct costs to the NHS of prophylaxis and screen- and -treat were calculated to be 8.17 and 18.34 per woman , respectively . CONCLUSIONS Prevalences of lower genital tract infections which have been implicated in increased rates of infective morbidity after abortion are similar to those reported elsewhere . Universal antibiotic prophylaxis is at least as effective as a policy of screen- and -treat in minimising the risk of short term infective morbidity and is far more cost efficient 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 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 The objective of this report was to review and describe the management of incomplete abortion by public sector hospitals . DESIGN A descriptive study in which data were collected prospect ively from routine hospital records on all women admitted with incomplete abortion to a stratified r and om sample of hospitals between 14 and 28 September 1994 . SETTING Public sector hospitals in South Africa . PATIENTS Women with incomplete abortions . MAIN OUTCOME MEASURES Length of hospital stay , details of medical management , details of surgical management , determinants of the above . MAIN RESULTS Data were collected on 803 patients from the 56 participating hospitals . Of these , 767 ( 95.9 % ) were in hospital for 1 day or more , and 753 ( 95.3 % ) women underwent evacuation of the uterus . Sharp curettage was the method employed in 726 ( 96.9 % ) and general anaesthesia was used for 601 ( 68 % ) of the women requiring uterine evacuation . Antibiotics were prescribed for 396 ( 49.5 % ) and blood transfusions were administered to 125 ( 17 % ) women . Statistical analysis showed length of stay to be longer in small hospitals ( under 500 beds ) and when the medical condition was more severe . Antibiotic usage and blood transfusion were more common with increasing severity and a low haemoglobin level on admission . However , some inappropriate management was identified with regard to both . MAIN CONCLUSIONS It is suggested that uncomplicated incomplete abortion can be more effectively and safely managed using the manual vacuum aspiration technique with sedation/analgesia as an outpatient procedure . Attention should be directed at the introduction of this management routine at all types of hospital and to the ensuring of appropriate management of women with complicated abortion 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 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 the procedure and for up to 8 additional doses . In 11 patients postabortion endometritis developed ; 2 had received the antibiotic and 9 had received a placebo ( P<.05 ) . Prophylactic cephalothin decreases the incidence of endometritis in patients undergoing midtrimester injection abortion . An injection-abortion interval greater than 24 hours appears to identify patients at increased risk for the development of postabortion endometritis Objective To determine whether prophylactic doxycycline at suction curettage for incomplete abortion decreases the rate of postoperative pelvic infection . Methods We r and omized 240 patients to receive intravenous doxycycline or placebo at curettage . Cervical specimens for gonorrhea and chlamydia were obtained preoperatively . Two weeks post-procedure , we evaluated all patients for infectious morbidity and repeated gonorrhea and chlamydia cultures . Statistical analysis used Mann-Whitney U test , McNemar test , or Fisher exact test , as appropriate . Results There were no statistically significant differences in age , parity , gestational age , history of sexually transmitted disease , pelvic inflammatory disease , or multiple sex partners between the doxycycline and placebo groups . Preoperative gonorrhea or chlam 
    Output:
    
No differences were detected in postabortal infection rates with routine prophylaxis or control .
However , compliance with antibiotic treatment was also low .
REVIEW ER 'S CONCLUSIONS There is not enough evidence to evaluate a policy of routine antibiotic prophylaxis to women with incomplete abortion