Give antibiotics before cesarean, ACOG advises

Antimicrobial prophylaxis should be given within an hour before the start of cesarean delivery

WEDNESDAY, AUGUST 25, 2010—All women undergoing cesarean delivery should receive antimicrobial prophylaxis within 60 minutes of the start of the delivery unless they’re already receiving appropriate antibiotics for issues such as chorioamnionitis, according to recommendations from the American Congress of Obstetricians and Gynecologists published in the September issue of Obstetrics & Gynecology.

In a new committee opinion, the Committee on Obstetric Practice notes that antimicrobial prophylaxis has typically been given intraoperatively after umbilical cord clamping due to concerns about interfering with newborn bacterial culture tests or contributing to infection with antibiotic-resistant organisms.

The authors write that a 2007 randomized, controlled trial found that cefazolin given preoperatively compared to after clamping was associated with less endometritis (1% versus 5%) and a decrease in total postoperative infection rates (4.5% versus 11.5%). Another study in 2005 also found a decrease in endometritis with cefazolin at incision compared to after cord clamping (7.8% versus 14.8%). Neither study found a significant decrease in rates of wound infection.

“From these data, it would appear that preoperatively administered antimicrobial prophylaxis does not appear to have any deleterious effects on mother or neonate. Preoperative administration significantly reduces endometritis and total maternal infectious morbidity compared with administration of antibiotics after umbilical cord clamping. These data further suggest that preoperative antimicrobial prophylaxis for cesarean delivery is not associated with an increase in neonatal infectious morbidity or the selection of antimicrobial resistant bacteria causing neonatal sepsis,” the authors write.

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