Antibiotic prophylaxis for fourth‐degree perineal tear during vaginal birth
Abstract
Background
One to eight per cent of women suffer third‐degree perineal tears (anal sphincter injury) and fourth‐degree perineal tear (rectal mucosa injury) during vaginal birth, and these tears are more common after forceps delivery (28%) and midline episiotomies. Fourth‐degree tears can become contaminated with bacteria from the rectum and this significantly increases in the chance of perineal wound infection. Prophylactic antibiotics might have a role in preventing this infection.
Objectives
To assess the effectiveness of antibiotic prophylaxis for reducing maternal morbidity and side‐effects in fourth‐degree perineal tear during vaginal birth.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 July 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 2), MEDLINE (1966 to 15 July 2005), and LILACS (1982 to 15 July 2005). We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 1 December 2009 and added the results to the awaiting classification section.
Selection criteria
Randomised controlled trials which reported data comparing outcomes of prophylactic antibiotics versus placebo or no antibiotics in fourth‐degree perineal tear during vaginal birth.
Data collection and analysis
No trials were found that met the selection criteria.
Main results
No randomised controlled trials were identified.
Authors' conclusions
There are insufficient data to support a policy of routine prophylactic antibiotics in fourth‐degree perineal tear during vaginal birth. A well‐designed randomised controlled trial is needed.
[Note: The two citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
PICOs
Plain language summary
Antibiotic prophylaxis for fourth‐degree perineal tear during vaginal birth
No trials looking at routine antibiotics for women with severe perineal tears at birth.
Most women are able to give birth without serious damage to their perineum. However, severe perineal trauma, which affects the muscle or tissue in the back passage, occurs in 1% to 8% of women giving birth and is common when forceps are used. There is an increased chance of infection when this happens, and antibiotics are often prescribed. The review of routine antibiotics for women with severe perineal tears found no trials. Hence, there is no strong evidence to support the effectiveness of prophylactic antibiotics in these situations. More research is needed.
