Antibiotic prophylaxis is recommended for all cesarean deliveries unless the patient is already receiving an antibiotic regimen with equivalent broad-spectrum coverage, according to new clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG). The updated practice bulletin reflects a limited change to clarify and provide additional information on recommendations from recent consensus guidelines for antimicrobial prophylaxis in surgery and the prevention of surgical site infections (SSIs). Among the (Level A) recommendations and conclusions:
- Antibiotic prophylaxis is recommended for all cesarean deliveries unless the patient is already receiving an antibiotic regimen with equivalent broad-spectrum coverage (eg, for chorioamnionitis), and such prophylaxis should be administered within 60 minutes before the start of the cesarean delivery.
- For cesarean delivery prophylaxis, a single dose of a targeted antibiotic, such as a first-generation cephalosporin, is the first-line antibiotic of choice, unless significant drug allergies are present.
- The addition of azithromycin, infused over 1 hour, to a standard antibiotic prophylaxis regimen may be considered for women undergoing a nonelective cesarean delivery.
- Vaginal cleansing before cesarean delivery in laboring patients and those with ruptured membranes using either povidine–iodine or chlorhexidine gluconate may be considered.
- Preoperative skin cleansing before cesarean delivery with an alcohol-based solution should be performed unless contraindicated.
- For patients with prelabor rupture of membranes (PROM) at < 34 0/7 weeks of gestation, antibiotic prophylaxis is indicated to prolong the latency period between membrane rupture and delivery.
- Antibiotic prophylaxis should not be used for pregnancy prolongation in women with preterm labor and intact membranes.
Use of prophylactic antibiotics in labor and delivery. ACOG Practice Bulletin No. 199. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;132:e103-19.
This Week's Must Reads
Term Cesarean Delivery & Subsequent Preterm Delivery, Am J Obstet Gynecol; ePub 2019 Feb 22; Vahanian, et al
Bleeding and Spotting with the LNG 13.5 mg IUS, Contraception; ePub 2019 Mar 1; Shimoni, et al
Apical Suspension at the Time of Vaginal Hysterectomy, Female Pelvic Med Reconstr Surg; ePub 2019 Feb 21; Sheyn, 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