Antimicrobial prophylaxis in obstetric and gynecologic surgery: a critical review

Thirty-three human studies concerned with antimicrobial prophylaxis in obstetric-gynecologic surgery were analyzed, with particular attention to experimental design. Eighty-two percent of the studies were prospective, 70% randomized and 39% double-blind. Patients were stratified according to underlying disease in 15%, complications of prophylaxis were mentioned in 61% of the studies, and statistical analysis was done in 55% of the studies. There was considerable variation in antibiotics employed and in the types of infection encountered. Twenty-seven of the 28 papers published after 1966 advocated prophylaxis. In contrast, less than two thirds of the papers concerned with general surgery support the use of perioperative prophylactic antibiotics. Despite some variability in methodology and antibiotic agents used, there is little controversy among the studies analyzed.