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Cochrane Database of Systematic Reviews

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

Información

DOI:
https://doi.org/10.1002/14651858.CD012136.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 02 noviembre 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Embarazo y parto

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Mercedes Bonet

    Correspondencia a: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

    [email protected]

  • Erika Ota

    Global Health Nursing, St. Luke's International University, Graduate School of Nursing Sciences, Tokyo, Japan

  • Chioma E Chibueze

    Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

  • Olufemi T Oladapo

    UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

Contributions of authors

All review authors were involved in development of the protocol. M Bonet and CE Chibueze assessed relevant trials, extracted, entered, and checked data from trials into Review Manager 5. All authors contributed to the interpretation of the data. M Bonet and CE Chibueze drafted the review. All authors read and approved the final version of the review for publication.

Sources of support

Internal sources

  • The Grant of National Center for Child Health and Development, Japan.

    27B‐10, 26A‐5

External sources

  • UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), the Department of Reproductive Health and Research (RHR), World Health Organization, Geneva, Switzerland.

  • Japan Agency for Medical Research and Development, Japan.

    The National Research Center for Child Health and Development, Japan receives government funding (AMED No.27300101) from the Clinical Research Program for Child Health and Development, AMED, Japan to support the Cochrane Pregnancy and Childbirth Satellite in Japan.

Declarations of interest

Mercedes Bonet: none known.

Erika Ota: none known.

Chioma E Chibueze contribution to this review was financially supported by a grant from the National Center for Child Health and Development, Japan 27B‐10, 26A‐5.

Olufemi T Oladapo: none known.

Acknowledgements

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

This work was supported by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization.

Chioma E Chibueze was financially supported by a grant from the National Center for Child Health and Development, Japan 27B‐10, 26A‐5.

The World Health Organization, Erika Ota, and Chioma E Chibueze retain copyright and all other rights in their respective contributions to the manuscript of this review, as submitted for publication.

As part of the pre‐publication editorial process, this review received comments from three peers (an editor and two referees who are external to the editorial team), a member of Cochrane Pregnancy and Childbirth's international panel of consumers, and the Group's Statistical Adviser.

Version history

Published

Title

Stage

Authors

Version

2017 Nov 02

Antibiotic prophylaxis for episiotomy repair following vaginal birth

Review

Mercedes Bonet, Erika Ota, Chioma E Chibueze, Olufemi T Oladapo

https://doi.org/10.1002/14651858.CD012136.pub2

2016 May 07

Antibiotic prophylaxis for episiotomy repair following vaginal birth

Protocol

Mercedes Bonet, Erika Ota, Chioma E Chibueze, Olufemi T Oladapo

https://doi.org/10.1002/14651858.CD012136

Differences between protocol and review

We adjusted the reporting of the outcomes 'wound infection' and 'wound dehiscence', as the included trial reported separately wound dehiscence with or without infection.

There are no other differences between the published protocol for this review and this full review (Bonet 2016b).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Female; Humans; Pregnancy;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

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Risk of bias summary: review authors' judgements about each 'risk of bias' domain
Figuras y tablas -
Figure 2

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

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

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

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

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

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

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

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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).

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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)

Figuras y tablas -
Summary of findings for the main comparison. Antibiotic prophylaxis compared to no treatment for episiotomy repair following vaginal birth
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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]
Figuras y tablas -
Comparison 1. Comparison 1. Antibiotic prophylaxis versus no treatment
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