Society of Family Planning Clinical Recommendation: Prevention of infection after abortion and pregnancy loss.

This Clinical Recommendation serves as a revision to the Society of Family Planning's 2010 Prevention of infection after induced abortion guidance. It examines infection risk, identifiable risk factors, and prophylactic measures for the prevention of infection associated with procedural and medication management of abortion and pregnancy loss to make evidence-based recommendations for the clinical care of patients. The following are the Society of Family Planning's recommendations: We recommend clinicians test and treat patients for gonorrhea and chlamydia at the time of abortion if there is (1) high clinical suspicion, (2) a positive diagnosis, or (3) the pregnant individual is under 25 years old and due for routine screening according to CDC guidelines; clinicians should not delay abortion while awaiting diagnosis or treatment (GRADE 1C). We recommend against screening for bacterial vaginosis (BV) before abortion (GRADE 1C). Since the rate of infection is low for nonprocedural abortion and the number needed to treat is high, coupled with inherent risks associated with antibiotic use, we recommend against the use of universal antibiotic prophylaxis in the setting of medication abortion, medication management of early pregnancy loss, or self-managed abortion (GRADE 1C). We recommend universal antibiotic prophylaxis for patients undergoing procedural abortion across all gestational durations (GRADE 1A). For procedural management of pregnancy loss, we recommend antibiotic prophylaxis (GRADE 1A). We recommend clinicians initiate antibiotic prophylaxis for procedural abortion and procedural management of pregnancy loss before instrumentation to maximize efficacy (GRADE 1B). Antibiotics should be given with adequate time for absorption, but data on the optimal timing for prophylaxis is lacking. In the setting of osmotic cervical dilator use, there is insufficient evidence to recommend for or against routine antibiotic prophylaxis before osmotic cervical dilator placement. We recommend discontinuing antibiotic prophylaxis after the procedure is completed (GRADE 1B). We recommend a single dose of doxycycline 200 mg orally or azithromycin 500 mg orally before a procedural abortion or procedural management of pregnancy loss (GRADE 1B). Metronidazole is a second-line option as it has evidence to suggest a prophylactic effect despite being less effective than doxycycline or azithromycin against aerobic bacteria. We recommend against the use of fluoroquinolones for prophylaxis in the setting of procedural abortion or procedural management of pregnancy loss due to the increased risk of side effects and complications (GRADE 1B). There is insufficient evidence to recommend for or against vaginal preparation with a local antiseptic solution or to recommend a specific vaginal preparation regimen before procedural abortion or procedural management of pregnancy loss.