Preventing infection after cesarean delivery: Evidence-based guidance
Clear recommendations supported by clinical research are offered here for hair removal, skin cleansing, and antibiotic prophylaxis—and, importantly, for the timing of these measures
Dr. Patrick is a Maternal-Fetal Medicine Fellow in the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville.
Dr. Deatsman is an Obstetrician-Gynecologist, Bronson Methodist Hospital, Kalamazoo, Michigan.
Dr. Duff is Associate Dean for Student Affairs and Professor of Obstetrics and Gynecology in the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville.
The authors report no financial relationships relevant to this article.
In this Article
Prepping the skin for surgery
Selecting the antibiotic(s) for infection prevention
Prophylaxis for the obese patient
What the evidence says
All women, regardless of weight, who will undergo cesarean delivery should receive a 2-g dose of cefazolin (Level II Evidence, Level 1B Recommendation; TABLE).If azithromycin is used in combination with cefazolin, an intravenous dose of 500 mg appears to provide adequate concentrations in serum and myometrium, but probably not in adipose tissue. More information is needed before we can make a firm recommendation about weight-based dosing of azithromycin.
CASE Resolved
For the 26-year-old obese laboring patient about to undergo cesarean delivery, reasonable steps for prevention of infection include removing the hair at the incision site with clippers or depilatory cream immediately prior to the start of surgery; cleansing the abdomen with a chlorhexidine-alcohol solution; and administering cefazolin (2 g) plus azithromycin (500 mg) preoperatively.
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