Antibiotic prophylaxis in obstetric and gynaecological procedures: a review

Surgical site infections are a common complication of obstetric and gynaecological surgeries; up to 10% of gynaecological patients undergoing an operative procedure will develop a surgical site infection. In surgeries with high rates of post-operative infection, antibiotic prophylaxis (using an antibiotic with an appropriate microbiological spectrum and administered in a timely manner) can play a major role in improving outcomes. This review examines the medical literature to assess the indications and appropriate antibiotic choices for prophylaxis to prevent surgical site infection in obstetric and gynaecological surgery. For some procedures, such as caesarean section, surgical termination of pregnancy and hysterectomy, antibiotic prophylaxis is clearly indicated. For other procedures, such as insertion of an intrauterine device, medical termination of pregnancy and laparoscopy, antibiotic prophylaxis is usually not required. For several other procedures where the evidence for antibiotic prophylaxis is unclear or inadequate, we discuss the current evidence for and against prophylaxis. Guidelines for infective endocarditic prophylaxis with surgery are also discussed.