Use of cephradine prophylaxis of infection after caesarean section; stepwise logistic regression analysis of relevant factors

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

“…Often a repeat section had been classified as elective by the study authors, but it was not always evident that all of these women were indeed not in labor and often the duration of membrane rupture was unclear. Fifty-two studies (N = 7765) were classified as undefined type of cesarean section (Adeleye 1981; Allen 1972; Apuzzio 1982; Bibi 1994; Bilgin 1998; Bourgeois 1985; Carl 2000; Chan 1989; Cormier 1989; De Boer 1989; Dillon 1981; Duff 1980; Engel 1984; Escobedo 1991; Gall 1979; Ganesh 1986; Gerstner 1980; Gibbs 1972; Gibbs 1973; Gordon 1979; Gummerus 1984; Hager 1983; Hagglund 1989; Ismail 1990; Jaffe 1985; Karhunen 1985; Kellum 1985; Kreutner 1978; Kristensen 1990; Lapas 1988; Levin 1983; Lewis 1990; Mallaret 1990; McCowan 1980; Miller 1968; Moro 1974; Morrison 1973; Ng 1992; Padilla 1983; Phelan 1979; Polk 1982; Reckel 1985; Rehu 1980; Roex 1986; Rudd 1981; Saltzman 1985; Stage 1982; Stiver 1983; Tully 1983; Turner 1990; Walss Rodriguez 1990; Yip 1997). One study reported both elective and emergency cesarean sections; the emergency sections, however, did not meet our definition of non-elective and these have been classified as “undefined” (Rouzi 2000).…”

“…Antibiotics for prophylaxis were administered intravenously either at the start of the operative procedure (“before cord”) or at or after clamping of the cord. In 36 studies (N = 5164), data on outcomes were available when the antibiotic had been administered before clamping of the cord (Adam 2005; Adeleye 1981; Allen 1972; Bibi 1994; Chan 1989; De Boer 1989; Duff 1980; Duff 1982; Freeman 1982; Gall 1979; Gerstner 1980; Gibbs 1972; Gibbs 1973; Hagglund 1989; Huam 1997; Jaffe 1984; Jaffe 1985; Kreutner 1978; Lapas 1988; Mahomed 1988; McCowan 1980: Miller 1968; Moodley 1981; Moro 1974; Morrison 1973; Ng 1992; Phelan 1979; Reckel 1985; Rehu 1980; Ross 1984; Rothbard 1975; Stage 1982; Turner 1990; Tzingounis 1982; Work 1977; Yip 1997). This was variably described as “pre-operatively”, “with induction of anaesthesia” or “before clamping of the cord”.…”

“…In 12 studies, the allocation concealment was adequate and although the randomization was unclear this was believed to be due to inadequate reporting rather than bias (Allen 1972; Dillon 1981; Fugere 1983; Hager 1983; Harger 1981; Hawrylyshyn 1983; Karhunen 1985; Moodley 1981; Moro 1974; Padilla 1983; Phelan 1979; Wong 1978). Seven studies were identified as quasi-RCTs (Bilgin 1998; Freeman 1982; Huam 1997; Kellum 1985; Morrison 1973; Rothbard 1975; Turner 1990).…”

“…We undertook a sensitivity analysis on the primary outcomes by study quality, omitting the seven quasi-RCTs (Bilgin 1998; Freeman 1982; Huam 1997; Kellum 1985; Morrison 1973; Rothbard 1975; Turner 1990). The overall findings remained very similar with reductions all the primary outcomes: febrile morbidity (average RR 0.46; 95% CI 0.40 to 0.53, 45 studies, 7323 women, random-effects [T 2 = 0.09, Chi 2 P = 0.001, I 2 = 44%]; wound infection (average RR 0.41; 95% CI 0.33 to 0.50, 72 studies, 11,223 women, random-effects [T 2 = 0.14, Chi 2 P = 0.05, I 2 = 23%); endometritis (RR 0.39; 95% CI 0.35 to 0.43, 73 studies, 11,274 women) and serious infectious morbidity remained the same as the main analysis contained no quasi-RCTs.…”