Antibiotic prophylaxis for cesarean section

The single most important risk factor for postpartum maternal infection is Cesarean delivery.

The objective of this review was to assess the effects of prophylactic antibiotic treatment on infectious complications in women undergoing Cesarean delivery.

We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register.

Randomised trials comparing antibiotic prophylaxis or no treatment for both elective and non-elective Cesarean section.

Two reviewers assessed trial quality and extracted data.

Sixty-six trials were included. Use of prophylactic antibiotics in women undergoing Cesarean section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after Cesarean section. The reduction in the risk of endometritis with antibiotics was similar across different patient groups. The relative risk for elective Cesarean section was 0.24, 95% confidence interval 0.11 to 0.48. The relative risk for non-elective Cesarean section was 0.30, 95% confidence interval 0.25 to 0.35. The relative risk for undefined or all patients together was 0.29, 95% confidence interval 0.26 to 0.33. Despite the large number of trials, different populations and different antibiotic regimens, there was no statistically significant heterogeneity.

The reduction of endometritis by two thirds to three quarters justifies a policy of administering prophylactic antibiotics to women undergoing elective or non-elective Cesarean section.