Prophylactic antibiotics for uterine evacuation procedures to manage miscarriage

Background

Procedural management of early pregnancy loss (EPL) involves removing any residual pregnancy tissue from the uterus. Clinical evidence and guidance are clear that antibiotic treatment is needed for women experiencing EPL, with signs and symptoms of infection. However, it is less clear whether prophylactic antibiotics are routinely required during procedural management in those without features of infection.

Objectives

To evaluate the effectiveness of routine antibiotic prophylaxis for women undergoing uterine evacuation procedures to manage early pregnancy loss.

Search methods

We searched the Cochrane Fertility Regulation Review Group trials register, CENTRAL, MEDLINE, Embase, Global Health (Ovid), Scopus (conference abstracts only), and grey literature in October 2023. We checked references and contacted study authors and experts in the field to identify additional studies.

Selection criteria

We included randomised controlled trials comparing prophylactic antibiotics with placebo or no treatment. Trials with a cluster‐randomised design and trials published only in abstract form were also eligible for inclusion. We included all types of EPL managed with surgical uterine evacuation. There was no gestational age limit. We excluded women with signs and symptoms of infection.

Data collection and analysis

Two review authors independently assessed trials for inclusion and risk of bias, extracted and checked data for accuracy, and assessed the certainty of evidence using the GRADE approach. We contacted the authors of the ongoing trial for additional information.