Antibiotic prophylaxis for episiotomy repair following vaginal birth

Bonet, Mercedes; Ota, Erika; Chibueze, Chioma Ezinne; Oladapo, Olufemi T.

doi:10.1002/14651858.cd012136.pub2

Cited by 23 publications

(18 citation statements)

References 20 publications

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“…There is insufficient evidence to determine whether routine administration of antibiotics before or immediately after incision or repair of episiotomy in women with an uncomplicated vaginal birth results in decreased episiotomy wound dehiscence or infection . A review identified one low‐quality quasi‐RCT from a public hospital in Brazil with 73 women.…”

Section: Resultsmentioning

confidence: 99%

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Wilson

Homer

2020

Aust NZ J Obst Gynaeco

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Background: Third-and fourth-degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third-and fourth-degree tears relative to countries of similar economic development. Aims:We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third-and fourth-degree perineal tears in Australian maternity centres. Materials and Methods:We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic. Results: Twenty-six systematic reviews were identified. The most common risk factors reported in the literature for third-and fourth-degree tears included primiparity, mother's ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births.Conclusions: Third-and fourth-degree perineal tears are associated with immediate and long-term implications for women and health systems. Evidence-based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do. K E Y W O R D Schild birth, obstetric labour complications, perineal tears, perineum, pregnancy SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article. Table S1. Systematic reviews.

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Section: Resultsmentioning

confidence: 99%

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Wilson

Homer

2020

Aust NZ J Obst Gynaeco

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“…Interleukin‐6 (IL‐6), as the most important inflammation‐related cytokine in the body, mainly regulates the cell function and is involved in the body immunity . High‐sensitivity C‐reactive protein (hs‐CRP), as the most widely used inflammation‐related cytokine currently, has a definite correlation with the severity of tissue damage and infection, which is an important index in clinical observation in acute infection stage …”

Section: Introductionmentioning

confidence: 99%

Risk factors, changes in serum inflammatory factors, and clinical prevention and control measures for puerperal infection

et al. 2019

Clinical Laboratory Analysis

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Background To investigate the risk factors and changes in serum inflammatory factors in puerperal infection, and propose clinical prevention measures. Methods A total of 240 subjects with suspected puerperal infection treated in our hospital from January 2017 to December 2017 were collected, among which puerperal infection was definitely diagnosed in 40 cases, and it was excluded in 40 cases. Levels of interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), and high‐sensitivity C‐reactive protein (hs‐CRP) were compared between the two groups, and the change trends of IL‐6 and hs‐CRP were recorded. Results Levels of IL‐6, hs‐CRP, and TNF‐α in puerperal infection group were higher than those in non‐infection group (P < .05). Levels of IL‐6 and hs‐CRP at enrollment and 1‐3 days after enrollment in infection group were higher than those in non‐infection group (P < .05). The body mass index >25, placenta previa, placenta accreta, postpartum hemorrhage, premature rupture of membrane, gestational diabetes mellitus, and anemia during pregnancy were relevant and independent risk factors for puerperal infection. Puerperal infection occurred in uterine cavity, vagina, pelvic peritoneum, pelvic tissue, incision, urinary system, etc, and gram‐negative (G+) bacteria were dominated in pathogens. Conclusion The inflammatory response of patients with puerperal infection is significantly enhanced.

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“…Whether to give antibiotic prophylaxis or not in women with episiotomy is one of the controversial issues in obstetrics; WHO, ACOG, and others are against it [ 30 – 33 ]; a Cochrane review weakly recommended it [ 34 ]. This study [ 14 ], however, has demonstrated the statistically significant difference in wound breakdown and perineal wound infection between the intervention and the placebo group, which is an important finding to consider prophylactic antibiotic after episiotomy and perineal tear.…”

Section: Discussionmentioning

confidence: 99%

Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis

Berhan

Kirba

Gebre

2020

Obstetrics and Gynecology International

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Background. Postpartum maternal infection is still a common problem worldwide, mainly due to obstetric risk factors. The use of prophylactic antibiotic at operative vaginal delivery (OVD), taking it as a standalone risk factor, has been controversial. The purpose of this review was to rigorously evaluate the association of OVD with postpartum infection and shed light on such highly controversial issue. Methods. A computer-based literature search was done mainly in the databases of PUBMED, HINARI health research, and the Cochrane library. Systematic review and meta-analysis were done by including 14 articles published between 1990 and August 2019. Results. The average absolute risk of postpartum infection at OVD from seven large cohort studies was 1%. Few studies showed a weak association of OVD with postpartum infection without being adjusted to perineal wound, but the pooled meta-analysis showed statistically significant association with non-OVD. In the included randomized trial, 97% of the study participants had perineal wound for whom repairs were performed; the risks of maternal infection and perineal wound breakdown were comparable, and maternal infections other than perineal wound infection did not show significant difference between prophylactic antibiotic and placebo groups. The majority of included studies demonstrated a strong association of postpartum infection and perineal wound dehiscence with episiotomy and perineal tear. Conclusion. Both the relative and absolute risks of postpartum infection at OVD are extremely low unless accompanied by episiotomy and 3rd/4tht degree perineal tear. From previous studies, there is no substantial evidence to use prophylactic antibiotic at OVD, but episiotomy and perineal tear.

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Antibiotic prophylaxis for episiotomy repair following vaginal birth

Cited by 23 publications

References 20 publications

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Risk factors, changes in serum inflammatory factors, and clinical prevention and control measures for puerperal infection

Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis

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