Usual Timing of Antibiotics in Cesarean Delivery Is Adequate


WASHINGTON — Nothing is gained by giving prophylactic antibiotics earlier than usual in the course of cesarean deliveries, W. Ashley Hood, D.O., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

The traditional approach to antibiotic prophylaxis in cesarean deliveries is to give the mother the drugs just after the cord is clamped. This prevents the antibiotics from being transmitted to the neonate, where they could mask neonatal infection and raise the risk that resistance will develop.

Some physicians argue that to best prevent maternal infection, however, antibiotics should be started just before skin incision so they will be on board as surgery commences. Proponents of this approach note that C-sections still account for 10% of all maternal mortality and that postcesarean infections—endometritis, wound infection, urinary tract infection, and pneumonia—are still a leading cause of maternal morbidity and death, said Dr. Hood of the University of Mississippi Medical Center, Jackson.

He and his associates assessed the effect of the timing of antibiotic prophylaxis in a study of 302 women undergoing nonelective cesarean delivery. Antibiotic prophylaxis was started at skin incision in 153 women and at cord clamping in 149. There were no significant differences between the two groups of patients in demographic characteristics, indications for cesarean delivery, or operative time.

There were fewer cases of postoperative endometritis in the group that received antibiotics at skin incision (12 patients, or 8%) than in the other group (22 patients, or 15%), but this difference was not statistically significant. The rates of wound infection also were similar, with 6 cases (4%) among women who received antibiotics at skin incision and 8 cases (5%) among those who received antibiotics at cord clamping.

Neonatal outcomes also were comparable between the two groups. Both groups had similar rates of neonatal sepsis, Apgar scores, and rates of admission to the neonatal intensive care unit, Dr. Hood said.

These findings confirm that it is still prudent to delay antibiotic prophylaxis until the cord is clamped, since giving the drugs earlier doesn't prevent more maternal infections or improve neonatal outcomes, he said.