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Postabortal Pelvic Sepsis in Association with Chlamydia Trachomatis
Author(s) -
Wein Peter,
Kloss Michael,
Garland Suzanne M.
Publication year - 1990
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1990.tb02026.x
Subject(s) - chlamydia trachomatis , pelvic inflammatory disease , chlamydia , sepsis , medicine , gynecology , immunology
EDITORIAL COMMENT: This paper reports that 5% of women having an elective termination of pregnancy, in Melbourne, in 1986, harboured Chlamydia trachomatis and that these women had triple the risk of postabortal sepsis. Expectedly the risk of postabortal sepsis when an IUD was inserted after termination was double in chlamydia positive women. Unless the problem of asymptomatic chlamydial infection is addressed in these women, many are likely to suffer impairment of fertility and/or the other miseries of chronic pelvic inflammatory disease. Although we accept the authors' statement that compliance for follow‐up is poor in such women, we are anxious to learn (and publish in this Journal) the state of tubal patency in such a group of patients. We also believe it is questionable practice to insert IUD's in nulliparas, especially after termination, unless there are unusual circumstances (repeated termination of unwanted pregnancies and refusal/inability to use other methods of contraception). The authors explain the need to use direct immunofluorescent staining for rapid diagnosis of chlamydial infection so that treatment with doxycycline can be commenced before termination is performed. Readers will have to scan the pages of Venereology to learn the more recent findings from the authors' clinic. Summary: Cervical swabs for Chlamydia trachomatis culture were taken from 527 women presenting for elective termination of pregnancy. Twenty‐six patients (4.9%) harboured C. trachomatis; 21 (81%) of these were less than 25‐years‐old and 21 (81%) were nulliparas. Postoperative pelvic sepsis developed in 11.5% of chlamydia‐positive women, in contrast to 3.6% of chlamydia‐negative women. Consequently it is suggested that all patients, especially those younger than 25 years, presenting for termination of pregnancy or in whom an intrauterine device is to be inserted should be screened and have treatment commenced for C. trachomatis prior to the operative procedure.