The challenge of prophylaxis in cesarean section in the 1990s

Physicians have evaluated the role of antibiotics in the prevention of perioperative infections since these drugs were discovered, but not until it was determined that antibiotics prevented staphylococcal wound infections in the animal model did surgeons consider their use for prophylaxis. In the 1970s, improved techniques in isolating and identifying anaerobic microorganisms and the unacceptably high incidence of infection-related complications convinced obstetricians to study, and ultimately accept, the use of perioperative antibiotic administration to prevent these infections. Recent progress has included refinement of the guidelines for patient selection and drug regimens. Although a single dose of an antibiotic given to the patient undergoing primary cesarean section has been demonstrated to be effective prophylaxis when administered after clamping the umbilical cord, this practice has not been widely accepted. With the discovery of cephamycins the role of these broad-spectrum antibiotics in obstetric and gynecologic surgery was investigated. One of the studies compared the efficacy of cefmetazole with that of cefotetan in preventing post-cesarean section infection. Eighteen patients in each group received a 2-g dose of one of the two drugs when the umbilical cord was clamped. Predetermined elevations in temperature were used to evaluate the presence of ensuing infections. Four subjects in each group developed some type of morbidity. Postoperative complications included wound infection, endometritis, bladder infection and cellulitis. Cefmetazole and cefotetan seemed equally effective in preventing post-cesarean section infections.