Adjunctive azithromycin prophylaxis protects women from uterine cesarean scar defect: A randomized controlled trial

Abstract

Introduction: Cesarean scar defect (CSD) is a long-term outcome of cesarean section (CS) and associated with numerous gynecological and obstetric problems. Previous studies indicate that infection may be a risk factor for CSD. Adjunctive azithromycin was shown to reduce the risk of postoperative infection in patients undergoing non-elective primary cesarean delivery in labor or after the rupture of membranes compared with standard antibiotic prophylaxis. This study investigated the protective effect of adjunctive azithromycin in combination with single-dose cephalosporin against CSD in women undergoing non-elective cesarean delivery. Material and methods:A randomized, double-blind, controlled clinical trial was conducted in a University hospital in Shanghai, China. A total of 242 women who underwent their first non-elective CS were randomly assigned to receive 1500 mg cefuroxime sodium plus 500 mg intravenous azithromycin (n = 121; experimental group) or 1500 mg cefuroxime sodium plus a placebo (n = 121; placebo group). The primary outcome was CSD prevalence, as determined by transvaginal ultrasound and saline infusion sonohysterography within 6 months of delivery. Secondary outcomes were changes in infectious indicators (eg hypersensitive C-reactive protein and procalcitonin), postoperative morbidity, and use of postoperative antibiotics. We also examined the operative procedure, pathogenic microorganism cultures, and fetal outcomes. Outcomes were compared between groups with the chi-squared test, Fisher's exact test, or Student's t test.Results: Between May 2018 and May 2021, 121 women were randomized to each arm. Because the sonographic follow up was disrupted by the coronavirus disease 2019 pandemic and strict management policies, we merged the follow-up time points (6 weeks and 6 months) into a single time period (6 weeks to 6 months); 104 and 108 women in the experimental and placebo groups, respectively, completed the first sonographic follow up. CSD was diagnosed by sonography in 34/104 (32.7%) and

Effect of adjunctive prophylactic macrolides used at the caesarean section on endometritis and surgical site wound infection: A meta‐analysis

“…Ten publications, published between 2003 and 2022, from a total of 1023 connected investigations that met the inclusion criteria were chosen and involved in the investigation. [26][27][28][29][30][31][32][33][34][35] The results of these researches are presented in Table 2. A total of 22 676 females with CS were in the chosen investigations' starting point, 14 034 of them were…”

“…Ten publications, published between 2003 and 2022, from a total of 1023 connected investigations that met the inclusion criteria were chosen and involved in the investigation 26‐35 . The results of these researches are presented in Table 2.…”

“…In investigations that were considered for the metaanalysis, 22 676 females with CS were in the chosen investigations' starting point, 14 034 of them were utilising APM, and 8642 were utilising control. [26][27][28][29][30][31][32][33][34][35] Adjunctive prophylactic macrolides had significantly lower SSWI, and endometritis compared with those with control in females with CS. However, care must be exercised when dealing with its values because of the low number of nominated investigations for the meta-analysis.…”

“…In investigations that were considered for the meta‐analysis, 22 676 females with CS were in the chosen investigations' starting point, 14 034 of them were utilising APM, and 8642 were utilising control 26‐35 . Adjunctive prophylactic macrolides had significantly lower SSWI, and endometritis compared with those with control in females with CS.…”

The presentation and management of cesarean scar defects: an updated review on an evolving diagnosis

“…Although some studies have demonstrated reduced CSD prevalence with decidual exclusion, others have indicated that judicious inclusion of the decidua may reduce CSD prevalence [53]. This observed benefit may result from a lower likelihood of inadvertent omission of the deep myometrial layers and a more physiologic reapproximation of the hysterotomy [41,57] Multidose perioperative antibiotics and adding a single dose of azithromycin to cephalosporin prophylaxis have been shown to reduce CSD prevalence [61,62].…”