Prophylactic Administration of Cefazolin Prior to Skin Incision versus Antibiotics at Cord Clamping in Preventing Postcesarean Infectious Morbidity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background/Aim: To summarize the published evidence of prophylactic cefazolin for cesarean delivery given before the procedure versus at cord clamping. Methods: We systematically searched the databases of PubMed, Embase, and CENTRAL in the Cochrane Library for randomized controlled trials that compared prophylactic antibiotics with cefazolin for cesarean delivery given before the procedure versus at cord clamping. Results: Six randomized controlled trials with high quality were included in this meta-analysis. Preoperative administration significantly reduced the risk of postpartum endometritis (RR: 0.57, 95% CI: 0.36-0.90, p = 0.02). Preoperative administration of cefazolin was not associated with a significant reduction in the risk of wound infection (RR: 0.70, 95% CI: 0.43-1.12) and urinary tract infection (RR: 1.19, 95% CI: 0.53-2.63). Furthermore, preoperative administration of cefazolin did not significantly affect proven neonatal sepsis (RR: 0.82, 95% CI: 0.47-1.42), suspected neonatal sepsis that requires a workup (RR: 0.94, 95% CI: 0.72-1.22), or neonatal intensive care unit admissions (RR: 0.90, 95% CI: 0.62-1.28). Conclusion: Pooled results demonstrated that antibiotic prophylaxis with cefazolin for cesarean delivery that is given before skin incision can significantly decrease the incidence of postpartum endometritis.

Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review

“…Reviews investigating the risk of fever , UTI or infections of the respiratory tract did not find a statistically significant difference between the different application time points – identical with our finding.…”

“…There were nine systematic reviews and three guidelines, one from the National Institute for Health and Clinical Excellence (NICE) , one from the American College of Obstetricians and Gynecologists (ACOG) and another one from the Society of Obstetricians and Gynaecologists of Canada (SOGC) , that examined maternal and neonatal infectious morbidity in women undergoing cesarean delivery receiving preoperative antibiotic prophylaxis compared with those receiving postoperative antibiotics. These reviews and guidelines were published between 2008 and 2015 and included between three and 10 randomized studies.…”

Antibiotic Use and Misuse during Pregnancy and Delivery: Benefits and Risks

“…Recently, research has been conducted to evaluate whether antibiotic prophylaxis before skin incision (as for gastrointestinal surgery) could further reduce postpartum maternal complications. Several reports have shown that antibiotics given before skin incision were more effective in reducing endometritis than when given after cord clamping (RR: 0.57; 95% CI = 0.36–0.90) [65,66,67]. However, it can be argued that this approach has several problems.…”

“…(1) Very few studies have investigated neonatal morbidity. These have shown that the rate of short-term complications was similar if antibiotics were given before or after cord clamping (neonatal sepsis (0.82; 95% CI = 0.47–1.42); suspected neonatal sepsis requiring a workup (RR: 0.94; 95% CI = 0.72–1.22); or neonatal intensive care unit admissions (RR: 0.90; 95% CI = 0.62–1.28)) [67]. Of note, there is no prospective study investigating the mid- or long-term effect on the infant.…”

Timing of Administration of Prophylactic Antibiotics for Caesarean Section

“…[5][6][7] In addition, preincision administration is recommended by practice guidelines. 4 I would presume that this practice is also widespread in other countries.…”