Antibiotic prophylaxis for cesarean section
Abstract
Background
The single most important risk factor for postpartum maternal infection is cesarean delivery.
Objectives
The objective of this review was to assess the effects of prophylactic antibiotic treatment on infectious complications in women undergoing cesarean delivery.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001).
Selection criteria
Randomized trials comparing antibiotic prophylaxis or no treatment for both elective and non‐elective cesarean section.
Data collection and analysis
Two reviewers assessed trial quality and extracted data.
Main results
Eighty‐one trials were included. Use of prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after cesarean section. The reduction in the risk of endometritis with antibiotics was similar across different patient groups: the relative risk (RR) for endometritis for elective cesarean section (number of women = 2037) was 0.38 (95% confidence interval (CI) 0.22 to 0.64); the RR for non‐elective cesarean section (n = 2132) was 0.39 (95% CI 0.34 to 0.46); and the RR for all patients (n = 11,937) was 0.39 (95% CI 0.31 to 0.43). Wound infections were also reduced: for elective cesarean section (n = 2015) RR 0.73 (95% CI 0.53 to 0.99); for non‐elective cesarean section (n = 2780) RR 0.36 95% CI 0.26 to 0.51]; and for all patients (n = 11,142) RR 0.41 (95% CI 0.29 to 0.43).
Authors' conclusions
The reduction of endometritis by two thirds to three quarters and a decrease in wound infections justifies a policy of recommending prophylactic antibiotics to women undergoing elective or non‐elective cesarean section.
PICOs
Plain language summary
Women taking antibiotics just before, during or just after their cesarean section operation, are much less likely to have infection of their womb (uterus) and wound
Women who have a cesarean section operation (removing the baby by surgery through the mother's abdomen) have an increased risk of infection. This can lead to serious complications, including death. The review of trials found evidence that it is beneficial for women to take antibiotic drugs (usually by injection) before, during or after their caesarean section, whether they have signs of infection or not (antibiotic prophylaxis). Women taking prophylactic antibiotics are much less likely to have endometritis (infection of the womb's lining) and wound infection. See also the Cochrane Review 'Antibiotic prophylaxis regimens and drugs for caesarean section'.
