[Antimicrobial prophylaxis for caesarean delivery: before or after cord clamping? A meta-analysis]

The objective of this systematic review was to assess the effect of preoperative rather than after umbilical cord clamping antimicrobial prophylaxis for caesarean delivery on maternal and neonatal infectious postoperative morbidity.

Meta-analysis.

Three electronic databases (Pubmed, Cochrane Central Register of Randomized Controlled Trials and Embase) were searched without language restriction and retrieved 201 potentially relevant trials. Five randomized controlled trials (n=1108) studying the timing of antimicrobial prophylaxis for caesarean section were included. The quality of included trials was assessed on the modified Oxford validity scale.

Preoperative administration of antibiotics (n=456) rather than after cord clamping (n=563) provides a significant reduction in the incidence of endometritis (Odds Ratio (OR) 0.59 [95% Confidence Interval (CI) 0.35-0.98]) and of total maternal infectious morbidity (OR 0.51 [95% CI 0.32-0.82]). This benefit was not observed regarding the incidence of wound infection (Peto OR 0.58 [95% CI 0.29-1.16]), neonatal infection (Peto OR 1.06 [95% CI 0.57-1.96]), neonatal sepsis workup (OR 1.02 [95% CI 0.67-1.54]), neonatal documented sepsis (Peto OR 0.93 [95% CI 0.43-2.02]) or neonatal intensive care unit admission (OR 0.97 [95% CI 0.61-1.56]). No significant heterogeneity was observed between the included studies.

This meta-analysis provides strong evidence that the preoperative rather than after cord clamping administration of antimicrobial prophylaxis for caesarean delivery provides a reduction in the incidence of endometritis and maternal total infectious morbidity without affecting the incidence of wound infection and neonatal infectious morbidity.