Therapeutic abortion and Chlamydia trachomatis infection

Abstract

Chlamydia trachomatis was isolated from the cervix of 30 of 218 (13.8%) women admitted for legal termination of pregnancy. During the first two weeks after the abortion seven of the 30 (23.3%) patients developed pelvic inflammatory disease. Four of these had serological evidence of recent active chlamydial infection. Thus, routine examination of patients for genital chlamydial infection before termination of pregnancy is recommended.

PIP: The study objective was to record the incidence of Chlamydia trachomatis infections among patients admitted for legal abortion in Ullevaal Hospital (Oslo, Norway) and to follow those women harboring chlamydia, particularly those in whom it caused postoperative infections. 218 women admitted consecutively for abortion in the 1st trimester in 1980 were included in the study. The abortion procedure used was dilatation and vacuum aspiration. The diagnosis of pelvic inflammatory disease (PID) was made on the clinical basis of pelvic pain, adnexal masses, increased erythrocyte sedimentation rate, and fever. Patients who developed acute salpingitis were treated with doxycycline. Patients who harbored C trachomatis were recalled for follow up about 3 months after the abortion. Of the 218 patients, C trachomatis was isolated from the cervix in 30 (13.8%), N gonorrheae in 2 (2.8%), and both C trachomatis and N gonorrheae in 2. 7 of the 30 (23.3%) patients harboring C trachomatis developed PID. All the infections occurred in the 1st 2 weeks after the abortion. None of the patients with cervical gonorrhea developed salpingitis. 21 of the chlamydia positive patients attended for follow up 3 months after the abortion. Of the 7 patients with pelvic infection, 6 attended. 4 of these women had an appreciable rise in chlamydial IgG antibody titre while 2 had raised but unchanged titres. Another 4 patients had a 4-fold or more rise in titre but no clinical evidence of infection. Study findings indicate that patients harboring C trachomatis in the cervix at abortion are at high risk of developing postoperative infections and that C trachomatis is a major etiological agent in salpingitis occurring after abortion.