Timing of Prophylactic Cephradine (1gm) and Metronidazole (1 gm) Administration for the Prevention of post Cesarean Section Infections and Its Effect on Neonates in Ain Shams University Maternity Hospital A Randomized Controlled Trial

Abstract

The purpose of this study is to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity or not. The study was conducted in Ain Shams University Maternity Hospital during the period from August 2013 to September 2014. The study was an interventional prospective randomized controlled clinical trial compared the difference of timing of prophylactic antibiotic before skin incision and after cord clamping, in preventing post-operative surgical site infection in women undergoing their first elective cesarean section. 552 Patients were randomly distributed according to computer generated randomization sheet into two groups: The study sample was divided into two equal groups as follows: Group I: Received antibiotics (cephradine) 30 minutes before skin incision. Group II: Received antibiotics (cephradine) after cord clamping. The antibiotic used was 1gm cephradine IV administered by an anesthesiologist. Postoperatively, both groups received "1gm cephradine every 8 hours (IV) + 500mg metronidazole rectal suppositories" every 12 for 24 hours. On discharge, both groups received "500mg cephradine orally every 8 hours + 500mg meteronidazole rectal suppositories every 12 hours" for 5 days. 552 subjects enrolled in the trial showedno statistically significant difference between both groups as regard as demographic data of participants included in this study (age, gestational age, BMI, parity). The preoperative investigations which were done for all participiant included in this study showed no statistically significant difference between both groups as regard as red blood cells, count, white blood cells count, random blood sugar and preoperative hemoglobin. The operation time and hospital stay of participiant included in the study showed, no statistically significant difference between group (I) who received antibiotic before skin incision with those who received antibiotic after cord clamping (group II). The number and percentage of post partumpatients who had wound infection complicated with fever 8 (2.9%) in group I while in group (II) 11 (4.0%) with no statistically significant difference between both groups. As regard the postpartum wound infection, there were 12 women in group I (4.4%), complicated with wound infection. 5 of them (1.8%) had only cellulitis and erythema, 6 of them (2.2%) had serous/serosanguinous exudates, only 1 of them (0.4%), had purulent exudates. While there were 15 women in group II (5.4%) complicated with wound infection. 8 of them (2.9%) had only cellulitis and erythema,5 of them (1.8%) had serous/ serosanguinous exudates, only 2 of them (0.7%) had purulent exudates, and 11 of them (4.0%) had wound infection with fever with no statistically significant difference between both groups. Post partumunwanted maternal outcomes in both groups, number and percentage of patients who had postpartum fever 15 in group (I) 5.4%, while 18 in group (II) 6.2% with no statistically significant difference between both groups. The patients who had postpartum complicated pneumonia was 2 (0.7%) in group (I), 3 (1.1%) in group (II) with no statistically significant between both groups. The patients who had postpartum UTI was 8 (2.9%) in group (I), while in group (II) eleven patients (4.0%) who had UTI with no statistically significant difference between both groups. The number and percentage of patients who had endometritis (1) with percentage 0.4% in group (I), (2) with percentage of 0.7% in group (II) with no statistically significant difference between both groups. The total infectious morbidity was 23 (8.3%) in group (I) and 31 (11.23%) in group II. This rate of total infectious morbidity was not reached significant difference and the effect of antibiotic administration is the same in both groups regarding therapeutic antibiotics used in group I 20 (7.3%) while in group II 23 (8.3%) also maternal allergy in group I was 2 with 0.7%, while in group II 1 case with 0.4% with no significant difference between both groups.