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

Abstract

The evidence in favor of prophylactic antibiotic administration before, in comparison with after, cord clamping for major maternal infections was of high quality, meaning that further research would be unlikely to change the confidence in these findings. However, we recommend additional research reflecting the precision of the effect estimates for neonatal outcomes.

Prophylactic antibiotics in caesarean delivery before or after cord clamping – protecting the mother at the expense of the infant’s microbiota?

“…A recent meta‐analysis by Bollig et al in 2017 reports composite postoperative infectious morbidities of 5.4% and 7.6%, respectively, if antibiotics were given before compared with after cord clamping. Composite postoperative infectious morbidity was defined by the authors of each randomised controlled trial, some also included urinary tract infections, pneumonia, pyelonephritis and fever in addition to endometritis and surgical‐site infection.…”

“…However, the timing of prophylactic antibiotics has only been debated more recently . The prevalence of combined postoperative morbidity is reported to be 5.4% and 7.6%, respectively, if antibiotics are given before skin incision compared with after cord clamping . More specifically, there is a 43% reduced risk of endometritis and a 38% reduced risk of surgical‐site infection with prophylactic antibiotics given before compared with after cord clamping .…”

“…The prevalence of combined postoperative morbidity is reported to be 5.4% and 7.6%, respectively, if antibiotics are given before skin incision compared with after cord clamping . More specifically, there is a 43% reduced risk of endometritis and a 38% reduced risk of surgical‐site infection with prophylactic antibiotics given before compared with after cord clamping . However, meta‐analyses of this topic do not distinguish between elective and emergency caesarean delivery, simply because of lack of studies into the latter.…”

“…Prophylactic antibiotics in caesarean delivery may interfere with the natural establishment of beneficial bacteria in the infant. Existing studies have not found signs of short‐term harmful effects to infants born at term, but these studies are not powered to detect rare outcomes and no long‐term follow up exists . Harmful long‐term effects of treatment with broad‐spectrum antibiotics both during pregnancy and during infancy have been reported in several other studies, such as increased risk of asthma and type 1 diabetes in observational studies and, for infants delivered preterm, cerebral palsy and neonatal death evaluated in a meta‐analysis of randomised clinical trials …”

“…There is observational evidence that infants with abnormal microbiota are at increased risk of immune‐related diseases such as atopic dermatitis and inflammatory bowel disease . Although there is no evidence of immediate harm to the neonate following exposure to pre‐incision prophylactic antibiotics, there is increasing evidence from observational studies of an imbalance in the infant gut microbiota of these children. When compared with vaginal delivery, the gut microbiota of children born by caesarean delivery are relatively more abundant in Clostridium and Lactobacillus genera, and less abundant in Bifidobacterium and Bacteroides up until 6 months of age, with the microbiota composition becoming increasingly similar thereafter .…”