Antibiotic prophylaxis for operative vaginal delivery

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Evidence-Based Medicine

Background:

• Operative vaginal deliveries (vacuum/forceps) increase postpartum infection risk.
• Antibiotic prophylaxis may prevent these infections, but its benefit is uncertain.
• This is an updated systematic review of randomized controlled trials.

Purpose of the Study:

• To assess antibiotic prophylaxis effectiveness and safety in reducing puerperal infections after operative vaginal delivery.
• To evaluate impact on wound infections, endometritis, and maternal outcomes.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials.
• Searched major databases including Cochrane, ClinicalTrials.gov, and ICTRP up to July 2019.
• Included women undergoing vacuum or forceps delivery without infection indications; interventions were any prophylactic antibiotic regimen.

Main Results:

• Antibiotic prophylaxis significantly reduced superficial and deep perineal wound infections (high-certainty evidence).
• Likely reduced wound breakdown and serious infectious complications.
• Effects on endometritis, organ/space infections, maternal adverse reactions, and length of stay remain unclear (low-certainty evidence).

Conclusions:

• Prophylactic antibiotics are effective for preventing perineal wound infections and serious complications in operative vaginal deliveries.
• Benefits regarding endometritis and other morbidities require further investigation.
• More research, especially in low- and middle-income settings, is needed to confirm findings.