Timing of Antibiotic Prophylaxis for Elective Cesarean Section: A Randomized Controlled Trial

Abstract

As the cesarean delivery is the most important factor associated with postpartum infection, prophylactic antibiotics recommended to reduce this infection, Because of concerns about the sequel of fetal antibiotic exposure with pre-incision administration; the standard has been the administration of antibiotic prophylaxis after delivery of the baby and clamping of the umbilical cord. There were a recent observations have challenged this policy of giving antibiotic prophylaxis after delivery of the baby to be given before skin incision with no fetal affection. Thus, there is a current debate on the time of prophylactic antibiotic in cesarean delivery. 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 and in the Department of Obstetrics and Gynecology of El Sahel Teaching Hospital, Cairo during the period from October 2013 to August 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 elective cesarean section. 330 Patients were randomly distributed according to computer generated randomization sheet into two groups: Control Group: (Group A) 165 patients: each patient received 1 gm. ceftriaxone i.v. after cord clamping. Intervention Group: (Group B) 165 patients: each patient received 1 gm. ceftriaone i.v. 30-60 minutes before skin incision. In the results of this study, we did not note a statistical difference in rates of post operative wound infection (P>0.05), endometritis, (P>0.05), or other maternal or neonatal infectious morbidity, between the two groups. Wound infection was the most common postpartum complication in both groups, the percentage of wound infection was less frequent in group B(Intervention group) than group A(Control group), but statistically no significant difference. There were 38 women in group A (Control group) (23.6%), complicated with wound infection. 15 of them (9.3%) had only cellulitis and erythema, 9 of them (5.6%) had serous/serosanguinous exudates, only 13 of them (8.1%), had purulent exudates,1 of them (0.6%) had Wound dehiscence, and 14 of them (8.7%) had wound infection with fever. While there were 33 women in group B (Intervention group) (20.6%) complicated with wound infection. 12 of them (7.5%) had only cellulitis and erythema,14 of them (8.8%) had serous/serosanguinous exudates, only 6 of them (3.8%) had purulent exudates, 1 of them (0.6%) had Wound dehiscence and10 of them (6.3%) had wound infection with fever. There was no significant difference between both groups concerning other maternal postpartum outcome. Postpartum Fever occurred in 24 women (14.9%) in group A (Control group), 14 of them (8.7%) had fever with wound infection, 2 of them had fever with dysuria (suspected UTI), 4 of them had fever with breast congestion and 4 of them had unexplained post partum pyrexia. The 14 patients who had fever with wound infection, 5 of them had only cellulitis and erythema, 2 of them had serous/serosanguinous exudates, and 7 of them had purulent exudates.