Transactions of the 71st Annual Meeting of the Central Association of Obstetricians and Gynecologists
Timing of prophylactic antibiotic administration in the uninfected laboring gravida: A randomized clinical trial

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Objective

The purpose of this prospective study was to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity.

Study design

In this double-blind placebo-controlled trial, cefazolin was given at skin incision (group A) or at cord clamping (group B). Patients were eligible for the trial if they had labored and required a cesarean delivery.

Results

Over a 30-month period 303 patients with singleton pregnancies entered the trial; 153-group A, 149-group B. Demographics, indication for cesarean delivery (P = .54), and operative time (P = .999), as well as rates of endometritis (RR 0.67, 95% CI 0.42–1.07), wound infection (RR 0.84, 95% CI 0.45–1.55), neonatal sepis (RR 1.28, 95% CI 0.91–1.79), and NICU admissions (RR 1.28, 95% CI 0.91–1.79) were similar between the 2 groups.

Conclusion

There was no difference in maternal infectious morbidity whether antibiotics were given before skin incision or at cord clamping.

Section snippets

Material and methods

In this prospective randomized study, women were eligible if they were in active labor and subsequently required a cesarean section. Patients were excluded if they had acute chorioamnionitis, allergy to penicillin or cephalosporins, cesarean section without labor, or the administration of systemic antibiotics within the past 2 weeks. Group B Strep prophylaxis (aqueous penicillin 5 million units IV then 3 million units q 4 hours), was allowed, and all patients, if indicated, received the same

Results

Over a 30-month period 342 patients with singleton pregnancies entered the trial. Twenty-three women in the skin incision group (A) and 21 in the cord clamp group (B) were found to have exclusion factors (Figure), leaving 153-group A, 149-group B. Patients were excluded if on final analysis, they were not in true, active labor (A = 12, B = 12), delivered vaginally before abdominal birth was performed (A = 4, B = 1). Chorioamnionitis was diagnosed (A = 4, B = 4), or antibiotics usage was confirmed during

Comment

Traditionally, prophylactic antibiotics are given preoperatively in obstetric/gynecologic procedures, and this is in keeping with general surgical principles. In 1961, Burke et al first demonstrated in an animal model that infection rates were decreased in contaminated skin wounds when antibiotics were given before contamination of the wound.11 This intuitive finding is widely accepted among the medical community and has been confirmed in many human studies. However, in the case of cesarean

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Presented at the 71st Annual Meeting of the Central Association of Obstetricians and Gynecologists, October 13-16, 2004, Washington, DC.

Reprints not available from the authors.

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