Are Antibiotics Warranted for Cesarean Delivery Before Onset of Labor?
Perioperative antibiotic prophylaxis substantially lowered risk for postpartum infection.
Because risk for infection is >50% among women who undergo cesarean delivery during labor, perioperative antibiotics are indicated for such patients. However, whether such prophylaxis is necessary for women who undergo cesarean delivery before the onset of labor is less clear. In a prospective observational study of 9432 women who underwent nonlaboring cesarean deliveries at term, investigators evaluated the efficacy of antibiotic prophylaxis. Participants were free of active infection during pregnancy or at delivery; 64% received perioperative antibiotics (most commonly, a cephalosporin).
At study entry, women who received antibiotics were at higher risk for infection than those who did not. Multivariate analyses showed that the odds of postpartum endometritis and of wound infection were significantly lower among women who received peripartum antibiotics (adjusted odds ratios, 0.4 and 0.5, respectively). The authors estimated that, to prevent one serious infection, 113 low-risk women would have to receive perioperative antibiotics. This high number needed to treat reflects low baseline rates of postpartum endometritis (2.2%) and wound infection (0.7%) in the hospitals that were involved in the study.
