Antimicrobial prophylaxis in gynaecological and obstetric surgery

Gynaecologic and obstetric surgery generally is prone to infections caused by bacteria from vagina. The vaginal flora contains normally more than 40 different microorganisms. Some of them are obligate pathogens, such as Chlamydia trachomatis, Neisseria gonorrhoeae and serogroup B streptococci, for other microbial species, like mycoplasmas and staphylococci, the pathogenicity is uncertain. The vaginal flora is under the influence of a great number of variables, such as endocrine factors, life style, contraception, and the use of tampons/pads. The recent literature on antibiotic prophylaxis in gynaecology and obstetrics is surveyed. The conclusions are: Antibiotic prophylaxis is recommended in: Abdominal hysterectomy (in high risk cases), in vaginal hysterectomy, fertility surgery, elective abortion and miscarriage (in carriers of C. trachomatis or N. gonorrhoeae), in cerclage (in endocervical colonization), Caesarean section (in high risk cases), and premature rupture of membranes. Great importance is attached to the prevention of infection of the neonates, with emphasis on the transmission of serogroup B streptococci and herpes simplex virus. The prevention of postoperative and postpartum urinary tract infections is discussed.