Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Surgical Site Infection Control

Background:

• Postoperative maternal infectious morbidity remains a significant concern following Cesarean delivery, particularly in resource-limited settings.
• Optimizing the timing of prophylactic antibiotic administration is crucial for effective infection prevention.

Purpose of the Study:

• To evaluate the optimal timing for administering prophylactic antibiotics during Cesarean delivery to minimize postoperative maternal infectious morbidity.
• To compare the efficacy of pre-incision versus post-cord clamping antibiotic administration in preventing Cesarean-related infections.

Main Methods:

• A randomized controlled trial involving 100 term primigravidae undergoing Cesarean delivery.
• Participants were assigned to receive intravenous Cefazoline either before skin incision (Group I) or immediately after cord clamping (Group II).
• Primary outcomes included surgical site wound infection, endometritis, and urinary tract infection.

Main Results:

• No significant differences in baseline patient characteristics were observed between the groups.
• Surgical site infections occurred in 3 cases in Group I and 4 cases in Group II (p > 0.05).
• Urinary tract infections were reported in 7 cases in Group I and 9 cases in Group II (p > 0.05).

Conclusions:

• Prophylactic antibiotic administration before skin incision or after cord clamping demonstrates comparable effectiveness in reducing postoperative infectious morbidity after Cesarean delivery.
• The findings suggest that current antibiotic timing protocols are likely adequate for infection prevention in low-resource settings.