Antibiotic prophylaxis for operative vaginal delivery
Abstract
Background
Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics are prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear.
Objectives
To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 June 2012).
Selection criteria
All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment.
Data collection and analysis
Four review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the included trial using the standard Cochrane criteria and the CONSORT statement of randomised controlled trials. We calculated the risk ratios using a fixed‐effect model and all the review authors interpreted and discussed the results.
Main results
One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. This trial identified only two out of the nine outcomes specified in this review. It reported seven women with endomyometritis in the group given no antibiotic and none in prophylactic antibiotic group. This difference did not reach statistical significance, but the risk ratio reduction was 93% (risk ratio 0.07; 95% confidence interval (CI) 0.00 to 1.21). There was no difference in the length of hospital stay between the two groups (mean difference 0.09 days; 95% CI ‐0.23 to 0.41).
Authors' conclusions
The data were too few and of insufficient quality to make any recommendations for practice. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.
PICOs
Plain language summary
Antibiotic prophylaxis for operative vaginal delivery
There is not enough evidence to support the use of antibiotic prophylaxis for operative vaginal delivery.
Vacuum and forceps assisted vaginal births are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal birth. Prophylactic antibiotics are used to prevent these infections. This review found only one randomised trial with methodological limitation, which revealed that prophylactic antibiotics did not significantly reduce the risk of endometritis and had no effect on length of maternal stay in hospital.
