[Antimicrobial prophylaxis for caesarean delivery: before or after cord clamping? A meta-analysis].

Abstract

OBJECTIVE:

The objective of this systematic review was to assess the effect of preoperative rather than after umbilical cord clamping antimicrobial prophylaxis for caesarean delivery on maternal and neonatal infectious postoperative morbidity.

STUDY DESIGN:

Meta-analysis.

METHODS:

Three electronic databases (Pubmed, Cochrane Central Register of Randomized Controlled Trials and Embase) were searched without language restriction and retrieved 201 potentially relevant trials. Five randomized controlled trials (n=1108) studying the timing of antimicrobial prophylaxis for caesarean section were included. The quality of included trials was assessed on the modified Oxford validity scale.

RESULTS:

Preoperative administration of antibiotics (n=456) rather than after cord clamping (n=563) provides a significant reduction in the incidence of endometritis (Odds Ratio (OR) 0.59 [95% Confidence Interval (CI) 0.35-0.98]) and of total maternal infectious morbidity (OR 0.51 [95% CI 0.32-0.82]). This benefit was not observed regarding the incidence of wound infection (Peto OR 0.58 [95% CI 0.29-1.16]), neonatal infection (Peto OR 1.06 [95% CI 0.57-1.96]), neonatal sepsis workup (OR 1.02 [95% CI 0.67-1.54]), neonatal documented sepsis (Peto OR 0.93 [95% CI 0.43-2.02]) or neonatal intensive care unit admission (OR 0.97 [95% CI 0.61-1.56]). No significant heterogeneity was observed between the included studies.

CONCLUSION:

This meta-analysis provides strong evidence that the preoperative rather than after cord clamping administration of antimicrobial prophylaxis for caesarean delivery provides a reduction in the incidence of endometritis and maternal total infectious morbidity without affecting the incidence of wound infection and neonatal infectious morbidity.

• Authors: E Boselli, L Bouvet, T Rimmelé, D Chassard, B Allaouchiche
• Journal: Annales francaises d'anesthesie et de reanimation (Ann Fr Anesth Reanim) Vol. 28 Issue 10 Pg. 855-67 (Oct 2009) ISSN: 1769-6623 [Electronic] France
• Vernacular Title: Antibioprophylaxie pour césarienne avant incision ou après clampage du cordon? Méta-analyse.
• PMID: 19767169 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Topics

• Antibiotic Prophylaxis
• Cesarean Section
• Clinical Protocols
• Constriction
• Female
• Humans
• Pregnancy
• Time Factors
• Umbilical Cord