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Profilaxis con antibióticos para la reparación de la episiotomía después del parto vaginal

Appendices

Appendix 1. LILACS search strategy

Search performed in LILACS

Step 1: ((antibiotico) OR (antibiótico) OR (antibiotics))

Step 2: ((episiotomia) OR (episiotomía) OR (episiotomy))

Appendix 2. Search terms for ICTRP and ClinicalTrials.gov

episiotomy AND antibiotics

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Risk of bias summary: review authors' judgements about each 'risk of bias' domain
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Figure 2

Risk of bias summary: review authors' judgements about each 'risk of bias' domain

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 1 Episiotomy infection with wound dehiscence.
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Analysis 1.1

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 1 Episiotomy infection with wound dehiscence.

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 2 Episiotomy wound dehiscence without infection.
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Analysis 1.2

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 2 Episiotomy wound dehiscence without infection.

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 3 Episiotomy wound dehiscence (overall with or without infection).
Figures and Tables -
Analysis 1.3

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 3 Episiotomy wound dehiscence (overall with or without infection).

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 4 Incidence of puerperal infection (endometritis).
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Analysis 1.4

Comparison 1 Comparison 1. Antibiotic prophylaxis versus no treatment, Outcome 4 Incidence of puerperal infection (endometritis).

Summary of findings for the main comparison. Antibiotic prophylaxis compared to no treatment for episiotomy repair following vaginal birth

Antibiotic prophylaxis compared to no treatment for episiotomy repair following vaginal birth

Patient or population: women with episiotomy repair following vaginal birth

Settings: public hospital, Brazil

Intervention: antibiotic prophylaxis with oral chloramphenicol 500 mg four times daily for 72 hours after episiotomy repair

Comparison: no treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Risk with no treatment

Risk with antibiotic prophylaxis

Incidence of episiotomy wound infection with wound dehiscence

Study population

RR 0.13
(0.01 to 2.28)

73
(1 quasi‐RCT)

⊕⊝⊝⊝
very low1,2

103 per 1000

14 per 1000
(1 to 257)

Incidence of episiotomy wound dehiscence without wound infection

Study population

RR 0.82
(0.29 to 2.34)

73
(1 quasi‐RCT)

⊕⊝⊝⊝
very low1,2

179 per 1000

151 per 1000
(52 to 439)

Incidence of puerperal infection (endometritis)

Study population

not estimable

73
(1 quasi‐RCT)

⊕⊝⊝⊝
very low1,3

There were no events in either group.

0 per 1000

0 per 1000
(0 to 0)

Incidence of severe maternal infectious morbidity

Study population

0
(0 RCT)

trial did not measure this outcome

Discomfort or pain at episiotomy wound site

0
(0 RCT)

trial did not measure this outcome

Women's satisfaction with care

0
(0 RCT)

trial did not measure this outcome

Adverse effects of antibiotics

Study population

0
(0 RCT)

trial did not measure this outcome

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 One study with very serious design limitations (‐2)
2 Wide confidence interval crossing the line of no effect, and few events (‐1)
3 No events (‐1)

Figures and Tables -
Summary of findings for the main comparison. Antibiotic prophylaxis compared to no treatment for episiotomy repair following vaginal birth
Comparison 1. Comparison 1. Antibiotic prophylaxis versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Episiotomy infection with wound dehiscence Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.28]

2 Episiotomy wound dehiscence without infection Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.29, 2.34]

3 Episiotomy wound dehiscence (overall with or without infection) Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.20, 1.35]

4 Incidence of puerperal infection (endometritis) Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Comparison 1. Antibiotic prophylaxis versus no treatment