Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Zarko Alfirevic; Gillian ML Gyte; Lixia Dou

doi:10.1002/14651858.CD008726

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Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 2

Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.5 Maternal fever (febrile morbidity).

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Figure 3

Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.7 Maternal urinary tract infection.

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Figure 4

Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.2 Maternal endometritis.

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Figure 5

Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.6 Maternal wound infection.

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Analysis 1.1

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 1 Maternal sepsis.

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Analysis 1.2

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 2 Maternal endometritis.

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Analysis 1.5

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 5 Maternal fever (febrile morbidity).

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Analysis 1.6

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 6 Maternal wound infection.

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Analysis 1.7

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 7 Maternal urinary tract infection.

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Analysis 1.9

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 9 Maternal composite serious infectious complication.

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Analysis 1.10

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 10 Maternal composite adverse effects.

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Analysis 1.11

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 11 Maternal allergic reactions.

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Analysis 1.12

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 12 Maternal nausea.

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Analysis 1.13

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 13 Maternal vomiting.

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Analysis 1.14

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 14 Maternal diarrhoea.

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Analysis 1.15

Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 15 Maternal skin rash.

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Analysis 2.1

Comparison 2 Cephalosporins versus penicillins ‐ by type of caesarean, Outcome 1 Maternal sepsis.

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Analysis 2.2

Comparison 2 Cephalosporins versus penicillins ‐ by type of caesarean, Outcome 2 Maternal endometritis.

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Analysis 3.1

Comparison 3 Cephalosporins versus penicillins ‐ by timing of administration, Outcome 1 Maternal sepsis.

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Analysis 3.2

Comparison 3 Cephalosporins versus penicillins ‐ by timing of administration, Outcome 2 Maternal endometritis.

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Analysis 4.1

Comparison 4 Cephalosporins versus penicillins ‐ by route of administration, Outcome 1 Maternal sepsis.

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Analysis 4.2

Comparison 4 Cephalosporins versus penicillins ‐ by route of administration, Outcome 2 Maternal endometritis.

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Analysis 5.2

Comparison 5 Cephalosporin (1^st generation B1) versus penicillins (extended spectrum A3), Outcome 2 Maternal endometritis.

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Analysis 5.5

Comparison 5 Cephalosporin (1^st generation B1) versus penicillins (extended spectrum A3), Outcome 5 Maternal fever (febrile morbidity).

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Analysis 5.6

Comparison 5 Cephalosporin (1^st generation B1) versus penicillins (extended spectrum A3), Outcome 6 Maternal wound infection.

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Analysis 5.10

Comparison 5 Cephalosporin (1^st generation B1) versus penicillins (extended spectrum A3), Outcome 10 Maternal composite adverse effects.

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Analysis 6.2

Comparison 6 Cephalosporin (1^st generation B1) versus penicillins (ampicillin A4), Outcome 2 Maternal endometritis.

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Analysis 6.5

Comparison 6 Cephalosporin (1^st generation B1) versus penicillins (ampicillin A4), Outcome 5 Maternal fever (febrile morbidity).

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Analysis 6.6

Comparison 6 Cephalosporin (1^st generation B1) versus penicillins (ampicillin A4), Outcome 6 Maternal wound infection.

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Analysis 6.7

Comparison 6 Cephalosporin (1^st generation B1) versus penicillins (ampicillin A4), Outcome 7 Maternal urinary tract infection.

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Analysis 6.10

Comparison 6 Cephalosporin (1^st generation B1) versus penicillins (ampicillin A4), Outcome 10 Maternal composite adverse effects.

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Analysis 6.15

Comparison 6 Cephalosporin (1^st generation B1) versus penicillins (ampicillin A4), Outcome 15 Maternal skin rash.

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Analysis 7.1

Comparison 7 Cephalosporin (2^nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 1 Maternal sepsis.

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Analysis 7.2

Comparison 7 Cephalosporin (2^nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 2 Maternal endometritis.

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Analysis 7.5

Comparison 7 Cephalosporin (2^nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 5 Maternal fever (febrile morbidity).

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Analysis 7.6

Comparison 7 Cephalosporin (2^nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 6 Maternal wound infection.

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Analysis 7.7

Comparison 7 Cephalosporin (2^nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 7 Maternal urinary tract infection.

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Analysis 7.10

Comparison 7 Cephalosporin (2^nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 10 Maternal composite adverse effects.

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Analysis 7.15

Comparison 7 Cephalosporin (2^nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 15 Maternal skin rash.

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Analysis 8.1

Comparison 8 Cephalosporin (2^nd generation B2) versus penicillins (ampicillin A4), Outcome 1 Maternal sepsis.

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Analysis 8.2

Comparison 8 Cephalosporin (2^nd generation B2) versus penicillins (ampicillin A4), Outcome 2 Maternal endometritis.

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Analysis 8.5

Comparison 8 Cephalosporin (2^nd generation B2) versus penicillins (ampicillin A4), Outcome 5 Maternal fever (febrile morbidity).

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Analysis 8.6

Comparison 8 Cephalosporin (2^nd generation B2) versus penicillins (ampicillin A4), Outcome 6 Maternal wound infection.

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Analysis 8.7

Comparison 8 Cephalosporin (2^nd generation B2) versus penicillins (ampicillin A4), Outcome 7 Maternal urinary tract infection.

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Analysis 8.10

Comparison 8 Cephalosporin (2^nd generation B2) versus penicillins (ampicillin A4), Outcome 10 Maternal composite adverse effects.

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Analysis 8.15

Comparison 8 Cephalosporin (2^nd generation B2) versus penicillins (ampicillin A4), Outcome 15 Maternal skin rash.

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Analysis 9.1

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 1 Maternal sepsis.

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Analysis 9.2

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 2 Maternal endometritis.

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Analysis 9.6

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 6 Maternal wound infection.

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Analysis 9.7

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 7 Maternal urinary tract infection.

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Analysis 9.9

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 9 Maternal composite serious infectious complication.

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Analysis 9.10

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 10 Maternal composite adverse effects.

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Analysis 9.11

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 11 Maternal allergic reactions.

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Analysis 9.12

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 12 Maternal nausea.

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Analysis 9.13

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 13 Maternal vomiting.

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Analysis 9.14

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 14 Maternal diarrhoea.

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Analysis 9.15

Comparison 9 Cephalosporin (3^rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 15 Maternal skin rash.

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Analysis 10.2

Comparison 10 Cephalosporin (3^rd generation B3) versus penicillins (ampicillin A4), Outcome 2 Maternal endometritis.

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Analysis 10.5

Comparison 10 Cephalosporin (3^rd generation B3) versus penicillins (ampicillin A4), Outcome 5 Maternal fever (febrile morbidity).

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Analysis 10.6

Comparison 10 Cephalosporin (3^rd generation B3) versus penicillins (ampicillin A4), Outcome 6 Maternal wound infection.

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Analysis 10.7

Comparison 10 Cephalosporin (3^rd generation B3) versus penicillins (ampicillin A4), Outcome 7 Maternal urinary tract infection.

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Analysis 10.10

Comparison 10 Cephalosporin (3^rd generation B3) versus penicillins (ampicillin A4), Outcome 10 Maternal composite adverse effects.

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Analysis 10.13

Comparison 10 Cephalosporin (3^rd generation B3) versus penicillins (ampicillin A4), Outcome 13 Maternal vomiting.

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Analysis 10.15

Comparison 10 Cephalosporin (3^rd generation B3) versus penicillins (ampicillin A4), Outcome 15 Maternal skin rash.

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Analysis 11.1

Comparison 11 Fluoroquinolones (C) vs penicillins (A), Outcome 1 Maternal sepsis.

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Analysis 11.2

Comparison 11 Fluoroquinolones (C) vs penicillins (A), Outcome 2 Maternal endometritis.

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Analysis 11.6

Comparison 11 Fluoroquinolones (C) vs penicillins (A), Outcome 6 Maternal wound infection.

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Analysis 11.7

Comparison 11 Fluoroquinolones (C) vs penicillins (A), Outcome 7 Maternal urinary tract infection.

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Analysis 12.1

Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 1 Maternal sepsis.

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Analysis 12.2

Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 2 Maternal endometritis.

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Analysis 12.6

Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 6 Maternal wound infection.

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Analysis 12.7

Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 7 Maternal urinary tract infection.

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Analysis 13.2

Comparison 13 Other antibiotic regimens (D to I) versus penicillins (A), Outcome 2 Maternal endometritis.

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Analysis 13.6

Comparison 13 Other antibiotic regimens (D to I) versus penicillins (A), Outcome 6 Maternal wound infection.

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Analysis 14.2

Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 2 Maternal endometritis.

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Analysis 14.5

Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 5 Maternal fever (febrile morbidity).

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Analysis 14.6

Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 6 Maternal wound infection.

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Analysis 14.7

Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 7 Maternal urinary tract infection.

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Analysis 15.2

Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 2 Maternal endometritis.

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Analysis 15.6

Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 6 Maternal wound infection.

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Analysis 15.7

Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 7 Maternal urinary tract infection.

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Analysis 15.29

Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 29 Stillbirth (not‐prespecified).

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Table 1. Classification of antibiotics

A. Penicillins	Penicillins consist of a thiazolidine ring connected to a B‐lactam ring to which is attached a side chain. The penicillin nucleus itself is the chief structural requirement for biological activity. Penicillins are the oldest class of antibiotics and function by inhibiting cell wall synthesis (bactericidal). A1. Natural penicillins are based on the original penicillin‐G structure. Examples include: penicillin G; procaine, penicillin V; benzathine. A2. Penicillinase‐resistant penicillins are active even in the presence of the bacterial enzyme that inactivates most natural penicillins. Examples include: cloxacillin; dicloxacillin; methicillin; nafcillin; oxacillin. A3. Extended spectrum penicillins which are effective against a wider range of bacteria. Examples include: ticarcillin; piperacillin; carbenicillin; timentin. A4. Aminopenicillins also have an extended spectrum of action compared with the natural penicillins. Examples include: ampicillin; amoxicillin.
B. Cephalosporins	Cephalosporins have a similar basic structure to penicillins but with different side chains. They function by inhibiting cell wall synthesis. B1. First generation cephalosporins; examples include: cephalothin; cefazolin; cephapirin; cephradine; cephalexin; cefadroxil. B2. Second generation cephalosporins; examples include: cefoxitin; cefaclor; cefuroxime; cefotetan; cefprozil; cefamandole, cefonicid; ceforanide, cefotiam. B3. Third generation cephalosporins, examples include: cefotaxime; ceftizoxime; ceftriaxon; cefpodoxime; cefditoren; ceftibuten; ceftazidine; cefcapene; cefdaloxime; cefetamet; cefixime; cefmenoxime; cefodizime; cefoperazone; cefpimizole. B4. Fourth generation cephalosporins, examples include: cefepime; cefpirome; cefclidine; cefluprenam; cefozopran; cefquinome.
C. Fluoroquinolones	The fluoroquinolones target the bacterial DNA gyrase and topoisomerase. They are potent bacteriocidal agents against a broad variety of micro‐organisms. Examples include: ciprofloxacin; levofloxacin; lomefloxacin; norfloxacin; sparfloxacin; clinafloxacin; gatifloxacin; ofloxacin; trovafloxacin.
D. Tetracyclines	Tetracyclines are bacteriostatic antibiotics active against a wide range of aerobes and anaerobic gram‐positive and gram‐negative bacteria. They inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome. Examples include: tetracycline; doxycycline; minocycline. Tetracyclines should not be used with children under 8 and specifically during teeth development as they can cause a permanent brown discolouration to the teeth. This antibiotic is, therefore, unlikely to be used at caesarean section.
E. Macrolides	Macrolide antibiotics inhibit bacterial protein synthesis. Resistance can arise. Examples include: erythromycin; clarithromycin; azithromycin.
F. Other beta‐lactams (carbapenems)	Carbapenems are beta‐lactams that have a broader spectrum of activity than most other beta‐lactam antibiotics. Examples include: imipenem; meropenem; ertapenem; aztreonam, mezlocillin.
G. Aminoglycosides	Aminoglycosides are first‐line therapy for a limited number of very specific, often historically prominent infections, such as plague, turaremia and tuberculosis. Examples include: streptomycin; gentamicin, kanamycin.
H. Lincosamides	Lincosamides are protein synthesis inhibitors which bind to the 50s subunit of bacterial ribosomes and inhibit early elongation of peptide chain by inhibiting transpeptidase reaction. Examples include: lincomycin; clindamycin.
I. Nitroimidazoles	Nitroimidazole is an imidazole derivative that contains a nitro group. It is used for the treatment of infection with anaerobic organisms. Examples include: metronidazole, tinidazol.
SeeGoodman 2008 for more detailed information about the classification and BNF 2009.

Table 1. Classification of antibiotics

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Comparison 1. Cephalosporins versus penicillins ‐ all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	3	421	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

1.1 Single cephalosporin vs single penicillin	2	346	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Single cephalosporin vs penicillin drug combination	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]
1.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	16	4263	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.93, 1.38]

2.1 Single cephalosporin vs single penicillin	8	2998	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.99, 1.57]
2.2 Single cephalosporin vs penicillin drug combination	7	1090	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.52, 1.18]
2.3 Cephalosporin drug combination vs single penicillin	1	92	Risk Ratio (M‐H, Fixed, 95% CI)	4.0 [0.46, 34.44]
2.4 Cephalosporin drug combination vs penicillin drug combination	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.77]
3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity) Show forest plot	13	2465	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.82, 1.28]

5.1 Single cephalosporin vs single penicillin	6	1212	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.79, 1.38]
5.2 Single cephalosporin vs penicillin drug combination	5	1078	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.57, 1.21]
5.3 Cephalosporin drug combination vs single penicillin	1	92	Risk Ratio (M‐H, Fixed, 95% CI)	3.5 [0.77, 15.96]
5.4 Cephalosporin drug combination vs penicillin drug combination	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	2.93 [0.63, 13.68]
6 Maternal wound infection Show forest plot	14	2104	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.51, 1.43]

6.1 Single cephalosporin vs single penicillin	8	1365	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.46, 1.56]
6.2 Single cephalosporin vs penicillin drug combination	4	564	Risk Ratio (M‐H, Fixed, 95% CI)	0.55 [0.16, 1.90]
6.3 Cephalosporin drug combination vs single penicillin	1	92	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.32, 27.79]
6.4 Cephalosporin drug combination vs penicillin drug combination	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.06, 15.09]
7 Maternal urinary tract infection Show forest plot	11	1564	Risk Ratio (M‐H, Fixed, 95% CI)	1.27 [0.84, 1.93]

7.1 Single cephalosporin vs single penicillin	6	988	Risk Ratio (M‐H, Fixed, 95% CI)	1.59 [0.95, 2.69]
7.2 Single cephalosporin vs penicillin drug combination	4	493	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.40, 1.70]
7.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.4 Cephalosporin drug combination vs penicillin drug combination	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

9.1 Single cephalosporin vs single penicillin	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects Show forest plot	5	2313	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [0.27, 7.43]

10.1 Single cephalosporin vs single penicillin	3	1902	Risk Ratio (M‐H, Fixed, 95% CI)	2.02 [0.18, 21.96]
10.2 Single cephalosporin vs penicillin drug combination	2	411	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.09, 10.50]
10.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Maternal allergic reactions Show forest plot	2	178	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

11.1 Single cephalosporin vs single penicillin	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.2 Single cephalosporin vs penicillin drug combination	1	119	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea Show forest plot	2	178	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

12.1 Single cephalosporin vs single penicillin	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.2 Single cephalosporin vs penicillin drug combination	1	119	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting Show forest plot	3	378	Risk Ratio (M‐H, Fixed, 95% CI)	7.0 [0.37, 133.78]

13.1 Single cephalosporin vs single penicillin	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.2 Single cephalosporin vs penicillin drug combination	2	319	Risk Ratio (M‐H, Fixed, 95% CI)	7.0 [0.37, 133.78]
13.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea Show forest plot	2	178	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

14.1 Single cephalosporin vs single penicillin	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.2 Single cephalosporin vs penicillin drug combination	1	119	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash Show forest plot	6	969	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.38, 4.32]

15.1 Single cephalosporin vs single penicillin	2	351	Risk Ratio (M‐H, Fixed, 95% CI)	1.45 [0.06, 35.38]
15.2 Single cephalosporin vs penicillin drug combination	4	618	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [0.34, 4.67]
15.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.1 Single cephalosporin vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.2 Single cephalosporin vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.3 Cephalosporin drug combination vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22.1 Single cephalosporin vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22.2 Single cephalosporin vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22.3 Cephalosporin drug combination vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23.1 Single cephalosporin vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23.2 Single cephalosporin vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23.3 Cephalosporin drug combination vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24.1 Single cephalosporin vs single penicillin	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24.2 Single cephalosporin vs penicillin drug combination	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24.3 Cephalosporin drug combination vs single penicillin	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25.1 Single cephalosporin vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25.2 Single cephalosporin vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25.3 Cephalosporin drug combination vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.1 Single cephalosporin vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.2 Single cephalosporin vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.3 Cephalosporin drug combination vs single penicillin	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
27.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
27.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
27.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
27.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28.1 Single cephalosporin vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28.2 Single cephalosporin vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28.3 Cephalosporin drug combination vs single penicillin	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28.4 Cephalosporin drug combination vs penicillin drug combination	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Cephalosporins versus penicillins ‐ all women

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Comparison 2. Cephalosporins versus penicillins ‐ by type of caesarean

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	3	421	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

1.1 Elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Non‐elective CS	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]
1.3 Both elective and non‐elective, or undefined CS	2	346	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	16	4167	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.93, 1.39]

2.1 Elective CS	2	292	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.62, 14.55]
2.2 Non‐elective CS	7	2562	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.96, 1.64]
2.3 Both elective and non‐elective, or undefined CS	7	1313	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.68, 1.28]
3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 Elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Non‐elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Both elective and non‐elective, or undefined CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 Elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Non‐elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Both elective and non‐elective, or undefined CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Cephalosporins versus penicillins ‐ by type of caesarean

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Comparison 3. Cephalosporins versus penicillins ‐ by timing of administration

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	3	421	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

1.1 Before cord clamping	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 After cord clamping	2	362	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]
1.3 Timing of administration not reported	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	16	4167	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.93, 1.39]

2.1 Before cord clamping	2	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.26 [0.07, 1.05]
2.2 After cord clamping	14	3767	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.97, 1.47]
2.3 Timing of administration nor reported	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 Before cord clamping	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 After cord clamping	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Timing of administration nor reported	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 Before cord clamping	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 After cord clamping	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Timing of administration nor reported	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Cephalosporins versus penicillins ‐ by timing of administration

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Comparison 4. Cephalosporins versus penicillins ‐ by route of administration

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	3	421	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

1.1 Intravenous administration	2	134	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]
1.2 Lavage/infiltration	1	287	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Route of administration not specified	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	16	4167	Risk Ratio (IV, Fixed, 95% CI)	1.15 [0.93, 1.40]

2.1 Intravenous administration	14	3676	Risk Ratio (IV, Fixed, 95% CI)	1.22 [0.96, 1.55]
2.2 Lavage/infiltration	2	491	Risk Ratio (IV, Fixed, 95% CI)	0.96 [0.65, 1.43]
2.3 Route of administration not specified	0	0	Risk Ratio (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 Intravenous administration	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Lavage/infiltration	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Route of administration not specified	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 Intravenous administration	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Lavage/infiltration	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Route of administration not specified	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Cephalosporins versus penicillins ‐ by route of administration

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Comparison 5. Cephalosporin (1st generation B1) versus penicillins (extended spectrum A3)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	2	814	Risk Ratio (M‐H, Fixed, 95% CI)	2.18 [1.30, 3.66]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity) Show forest plot	1	139	Risk Ratio (M‐H, Fixed, 95% CI)	2.36 [0.84, 6.62]

6 Maternal wound infection Show forest plot	1	139	Risk Ratio (M‐H, Fixed, 95% CI)	2.02 [0.42, 9.63]

7 Maternal urinary tract infection	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects Show forest plot	1	675	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Cephalosporin (1st generation B1) versus penicillins (extended spectrum A3)

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Comparison 6. Cephalosporin (1st generation B1) versus penicillins (ampicillin A4)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	5	1233	Risk Ratio (M‐H, Fixed, 95% CI)	1.21 [0.85, 1.72]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity) Show forest plot	4	751	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.71, 1.68]

6 Maternal wound infection Show forest plot	3	372	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.35, 4.05]

7 Maternal urinary tract infection Show forest plot	3	372	Risk Ratio (M‐H, Fixed, 95% CI)	1.97 [0.91, 4.23]

8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects Show forest plot	2	861	Risk Ratio (M‐H, Fixed, 95% CI)	0.32 [0.01, 7.84]

11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash Show forest plot	1	193	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 6. Cephalosporin (1st generation B1) versus penicillins (ampicillin A4)

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Comparison 7. Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	1	287	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 Maternal endometritis Show forest plot	4	1334	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.82, 1.56]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity) Show forest plot	4	850	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.79, 1.47]

6 Maternal wound infection Show forest plot	2	438	Risk Ratio (M‐H, Fixed, 95% CI)	2.39 [0.74, 7.69]

7 Maternal urinary tract infection Show forest plot	3	567	Risk Ratio (M‐H, Fixed, 95% CI)	1.43 [0.76, 2.71]

8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects Show forest plot	2	1030	Risk Ratio (M‐H, Fixed, 95% CI)	2.02 [0.18, 21.96]

11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash Show forest plot	1	129	Risk Ratio (M‐H, Fixed, 95% CI)	2.70 [0.11, 64.96]

16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 7. Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3)

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Comparison 8. Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

2 Maternal endometritis Show forest plot	7	1714	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.75, 1.35]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity) Show forest plot	3	387	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.64, 2.15]

6 Maternal wound infection Show forest plot	4	462	Risk Ratio (M‐H, Fixed, 95% CI)	1.97 [0.50, 7.75]

7 Maternal urinary tract infection Show forest plot	4	462	Risk Ratio (M‐H, Random, 95% CI)	0.63 [0.11, 3.66]

8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects Show forest plot	2	954	Risk Ratio (M‐H, Fixed, 95% CI)	1.92 [0.18, 20.82]

11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash Show forest plot	2	462	Risk Ratio (M‐H, Fixed, 95% CI)	0.84 [0.18, 3.86]

16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 8. Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4)

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Comparison 9. Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 Maternal endometritis Show forest plot	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	2.14 [1.14, 4.00]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Maternal wound infection Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7 Maternal urinary tract infection Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

10 Maternal composite adverse effects Show forest plot	2	359	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

11 Maternal allergic reactions Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

12 Maternal nausea Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

13 Maternal vomiting Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

14 Maternal diarrhoea Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

15 Maternal skin rash Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 9. Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3)

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Comparison 10. Cephalosporin (3rd generation B3) versus penicillins (ampicillin A4)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	4	726	Risk Ratio (M‐H, Fixed, 95% CI)	1.47 [0.89, 2.42]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity) Show forest plot	2	314	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.48, 2.23]

6 Maternal wound infection Show forest plot	5	810	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.13, 0.76]

7 Maternal urinary tract infection Show forest plot	2	233	Risk Ratio (M‐H, Fixed, 95% CI)	0.52 [0.10, 2.80]

8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects Show forest plot	1	293	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	7.0 [0.37, 133.78]

14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash Show forest plot	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.12, 72.77]

16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 10. Cephalosporin (3rd generation B3) versus penicillins (ampicillin A4)

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Comparison 11. Fluoroquinolones (C) vs penicillins (A)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	2.55 [0.11, 60.57]

2 Maternal endometritis Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.68, 2.01]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Maternal wound infection Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	4.25 [0.21, 85.51]

7 Maternal urinary tract infection Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.01, 1.69]

8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 11. Fluoroquinolones (C) vs penicillins (A)

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Comparison 12. Fluoroquinolones (C) vs cephalosporins (B)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.07, 16.63]

2 Maternal endometritis Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [0.76, 2.19]

3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Maternal wound infection Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [0.20, 22.82]

7 Maternal urinary tract infection Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 12. Fluoroquinolones (C) vs cephalosporins (B)

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Comparison 13. Other antibiotic regimens (D to I) versus penicillins (A)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis	0		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
1.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	1	82	Risk Ratio (M‐H, Fixed, 95% CI)	0.29 [0.10, 0.82]

2.1 Lincosamide (H) + aminoglycoside (G) vs penicillins (A)	1	82	Risk Ratio (M‐H, Fixed, 95% CI)	0.29 [0.10, 0.82]
3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 Lincosamide (H) + aminoglycoside (G) vs penicillins (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 Lincosamide (H) + aminoglycoside (G) vs penicillins (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.1 Lincosamide (H) + aminoglycoside (G) vs penicillins (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Maternal wound infection Show forest plot	1	82	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.09, 2.46]

6.1 Lincosamide (H) + aminoglycoside (G) vs penicillins (A)	1	82	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.09, 2.46]
7 Maternal urinary tract infection	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.1 Lincosamide (H) + aminoglycoside (G) vs penicillin (A)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 13. Other antibiotic regimens (D to I) versus penicillins (A)

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Comparison 14. Other antibiotic regimens (D to I) versus cephalosporins (B)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.08, 17.82]

2.1 Beta‐lactams (F) versus cephalosporins (B)	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.08, 17.82]
3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity) Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.06, 6.09]

5.1 Beta‐lactams (F) versus cephalosporins (B)	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.06, 6.09]
6 Maternal wound infection Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.02, 9.15]

6.1 Beta‐lactams (F) versus cephalosporins (B)	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.02, 9.15]
7 Maternal urinary tract infection Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

7.1 Beta‐lactams (F) versus cephalosporins (B)	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.1 Beta‐lactams (F) versus cephalosporins (B)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 14. Other antibiotic regimens (D to I) versus cephalosporins (B)

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Comparison 15. Other antibiotic regimens versus different antibiotic regimens

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Maternal sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Maternal endometritis Show forest plot	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.29, 2.26]

2.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.29, 2.26]
3 Infant sepsis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Infant oral thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Maternal fever (febrile morbidity)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Maternal wound infection Show forest plot	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	3.23 [0.34, 30.64]

6.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	3.23 [0.34, 30.64]
7 Maternal urinary tract infection Show forest plot	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.07, 17.03]

7.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.07, 17.03]
8 Maternal thrush	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal composite serious infectious complication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal composite adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Maternal allergic reactions	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Maternal nausea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Maternal vomiting	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 Maternal diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Maternal skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Immediate infant adverse effects	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Infant unsettled	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18 Infant diarrhoea	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
18.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19 Infant skin rash	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
19.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20 Development of bacterial resistance	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
20.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
21 Maternal length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
21.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Infant length of hospital stay	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23 Infant's immune system development	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
23.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24 Infant general health	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
24.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25 Infant frequency of hospital visits	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
25.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Costs	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Post‐discharge infections ‐ up to 30 days (not pre‐specified)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
28 Maternal readmissions to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
29 Stillbirth (not‐prespecified) Show forest plot	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	0.27 [0.03, 2.38]

29.1 Aminoglycoside (G) + nitroimidazole (I) vs standard regimen	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	0.27 [0.03, 2.38]

Comparison 15. Other antibiotic regimens versus different antibiotic regimens

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