There is a significant risk of introducing infection into the upper genital tract when instrumenting the uterus, particularly in women at high risk of a sub-clinical cervical chlamydial infection (e.g. under 25-year olds). The most common indications for instrumenting the uterus are therapeutic surgical termination of pregnancy, insertion of an IUCD and investigations for subfertility. It is now considered mandatory to offer either a 'screen and treat' policy or routine prophylaxis for all women undergoing such management. In cases where a 'screen and treat' policy is inappropriate, for example, insertion of an IUCD for emergency contraception, it is essential to ensure adequate prophylaxis and a single 1 g dose of azythromicin is recommended.
Particular care needs to be taken in patients who are on immunosuppressant treatment (e.g. renal transplant patients) or in those who are immunocompromised because of chemotherapy or HIV.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.