A previous study of infection and morbidity in 400 women attending for termination of pregnancy (TOP) had shown that 32 (8%) harboured cervical Chlamydia trachomatis and 112 (28%) had anaerobic (bacterial) vaginosis (AV). Fifty-three per cent of the women with preoperative C. trachomatis had AV. Thirty of the 32 women with chlamydial infection were followed up and 19 (63%) of these developed post-abortion upper genital tract infection, 7 of whom needed re-admission. In view of the high morbidity in women with chlamydial infection attending for TOP, anti-bacterial prophylaxis with metronidazole suppositories and oral oxytetracycline was introduced for women attending for suction termination of pregnancy (STOP). An audit of the clinical and financial benefits and/or losses was carried out. The audit of 1951 consecutive patients attending for STOP revealed that 132 (6.8%) had chlamydial infection with equivocal results reported in a further 2 patients. One hundred and eight of the 134 women responded to recall. Full genital tract infection screening was carried out in 105 of the 108 recalled patients of whom 5 had repeat positive cervical swabs for C. trachomatis, one had Trichomonas vaginalis, 24 had candidiasis and 17 had anaerobic vaginosis, none had gonorrhoea. Thirteen (12%) of the 108 women had pelvic infection as previously defined, none of whom required re-admission. At least pound sterling 20,000 has been saved each year in our Trust following the introduction of pre-abortion chlamydial screening and universal antichlamydial and anti-anaerobe prophylaxis. The introduction of universal prophylaxis against C. trachomatis and AV has profoundly reduced morbidity in patients attending for TOP and has also resulted in substantial financial savings.
PIP: This paper presents an audit of the clinical and financial benefits and/or losses of a new management protocol for Chlamydia trachomatis and anaerobic vaginosis (AV) in women requesting suction termination of pregnancy (STOP). This management protocol is known as the Singleton Regimen and involves the introduction of an antibacterial prophylaxis with metronidazole suppositories and oral oxytetracycline. The audit included 1951 patients requesting STOP at the Singleton Hospital between January 1992 and October 1993; 132 of them had chlamydial infection. A total of 108 women responded to recall. Full genital tract infection screening was carried out in 105 of the 108 recalled patients. Of the 105 patients, 5 had repeat positive cervical swabs for C. trachomatis, 1 had Trichomonas vaginalis, 24 had candidiasis, and 17 had anaerobic vaginosis. 13 of the 108 women had pelvic infection; none of them required readmission. In conclusion, the introduction of universal prophylaxis against C. trachomatis and AV has significantly reduced morbidity in patients obtaining a termination of pregnancy and has also resulted in substantial financial savings.