The American College of Obstetricians and Gynecologists (ACOG) has issued clinical management guidelines for the prevention of infection after gynecologic procedures. The practice bulletin reviews the recommended interventions, including antibiotic prophylaxis, used to prevent infection following gynecologic procedures. Among the ACOG recommendations:
- Implement perioperative glycemic control and use blood glucose target levels of <200 mg/dL in patients with and without diabetes.
- Perform preoperative surgical site skin preparation with an alcohol-based agent unless contraindicated. Chlorhexidine–alcohol is an appropriate choice.
- Patients undergoing vaginal, abdominal, laparoscopic, or robotic hysterectomy, including supracervical hysterectomy, should receive single-dose antimicrobial prophylaxis.
- Routine antibiotic prophylaxis is not recommended before IUD insertion.
- Antimicrobial prophylaxis should be administered to women undergoing uterine evacuation for induced abortion.
- Advise patients to shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before abdominal surgery.
- Antibiotic prophylaxis is not recommended for routine hysteroscopic procedures.
- Routine antibiotic prophylaxis is not recommended for women undergoing urodynamic testing.
- All infections remote to the surgical site, such as skin or urinary tract infections, should be identified and treated before an elective operation. Elective operations on patients with remote site infections should be postponed until the infection has resolved.
Prevention of infection after gynecologic procedures. ACOG Practice Bulletin No. 195. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131:e172–89.
This Week's Must Reads
Umbilical cord milking tied to severe IVH in very premature neonates, Katheria AC et al. The Pregnancy Meeting, late breaking abstract 1.
Ehlers-Danlos syndrome: Increased IUGR risk reported, Nicholls-Dempsey L et al. Am J Obstet Gynecol. 2019 Jan;220(1):S381-382. Abstract 574
Universal HCV Testing in Prenatal Care, Obstet Gynecol; ePub 2019 Jan 8; Tasillo, et al
Is GDM Associated with Neonatal Respiratory Morbidity?, Obstet Gynecol; ePub 2019 Jan 8; Werner, et al
POP and UI Knowledge in Bariatric Surgery, Female Pelvic Med Reconstr Surg; ePub 2019 Jan 11; Paka, et al
Must Reads in Clinical Guidelines
ACOG: Chronic Hypertension in Pregnancy, Obstet Gynecol; ePub 2019 Jan; Vidaeff, et al
ACOG Guidelines: Pregestational Diabetes Mellitus, Obstet Gynecol; ePub 2018 Dec; ACOG, et al
Management of Early Pregnancy Loss, Obstet Gynecol; ePub 2018 Nov; ACOG
Prophylactic Antibiotic Use in Labor & Delivery, Obstet Gynecol; 2018 Sep; Coleman, et al
USPSTF on Screening for Cervical Cancer, JAMA; 2018 Aug 21; US Preventive Services Task Force