Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery: A Systematic Review

Abstract

A s the prevalence of obesity grows in the United States, rates of surgical weight-loss procedures have increased significantly, with women (particularly those of reproductive age) accounting for many of these surgeries. How this affects pregnancy is not clearly understood. The authors of this meta-analysis estimated bariatric surgery rates among women aged 18 to 45 years and reviewed the literature on the effects of these procedures on fertility rates and pregnancy outcomes.The authors searched the Nationwide Inpatient Sample (1998Sample ( to 2005 and databases of Medline, EMBASE, Controlled Clinical Trials Register, and the Cochrane Database of Reviews of Effectiveness between 1984 and February 2008 for references on bariatric surgery in women of reproductive age. Of the 260 screened articles, 75 reviews and studies were considered eligible, with information abstracted about study design, fertility, nutritional, neonatal, and pregnancy outcomes after all types of bariatric surgery.The incidence of bariatric surgery in the United States increased 800% between 1998 and 2005 (growing from 12,480 to 113,500 cases annually). Women aged 18 to 45 years made up 49% of all patients undergoing weight-loss surgery (>50,000 cases annually) for the 3 most recent years. Lower maternal complications, approaching the level of nonobese controls, were found among women who had bariatric surgery before pregnancy when compared with obese women without surgery in 3 matched cohort studies. Women who underwent laparoscopic adjustable gastric band surgery had lower rates of gestational diabetes (0% vs. 22.1%; P<0.05) and preeclampsia (0% vs. 3.1%; P<0.05). These findings were supported by 13 other retrospective bariatric cohort trials. Overall, neonatal outcomes after laparoscopic adjustable gastric band were similar or better than in obese women without surgery, in terms of premature delivery (7.7% vs. 7.1%), low birth weight (7.7% vs. 10.6%; P<0.05), and macrosomia (7.7% vs. 14.6%; P<0.05). There were no significant differences in neonatal outcomes after gastric bypass surgery compared with nonobese controls or obese women who did not have surgery. These findings were supported by 10 studies. Six studies addressed fertility outcomes after bariatric surgery, but these were small and provided no clear results. Twenty reports found complications requiring surgical intervention during pregnancy, primarily for the relief of bowel obstruction, in parturients who had undergone bariatric surgery. The effect of bariatric surgery on the rate of cesarean section was unclear. There also was no strong evidence to guide pregnancy delay following bariatric surgery, although the typical recommendation reported in this article was 1 year.The authors concluded that available evidence suggests that rates of adverse maternal and neonatal outcomes may be lower in women who undergo weight-loss surgeries before becoming pregnant. Most of these studies, however, had design deficiencies, such as small patient numbers and potential selection bias. They reco...

A prospective randomised clinical trial of prophylactic antibiotic in caesarean delivery and fetomaternal outcome

“…[5][6][7][8] So, a prospective randomized clinical trial was undertaken to notice whether prophylactic antibiotic given before skin incision than after cord clamping, was more effective for preventing infectious morbidities of mother and newborn baby following caesarean delivery.…”

Single dose antibiotic prophylaxis in elective obstetric and gynaecological surgeries-a descriptive study

“…17 The timing of antibiotic prophylaxis was not specifically addressed in the review. 18 Surgical antimicrobial prophylaxis refers to a very short course of an antimicrobial agent initiated just before an operation begins. [19][20][21][22] Antimicrobial prophylaxis is an attempt to not sterilize tissues, but a critically timed adjunct used to decrease the microbial burden of intraoperative contamination to a level that cannot overwhelm host immunity.…”

Analysis of Postoperative Morbidity Following Caesarean Sections in a Tertiary Care Centre

“…TheUnited States has a pregnancy related deaths per 100,000 live births, with approximately 10% resulting from puerperal infection (3,4) . Caesarean section is the most important risk factor for puerperal infection (5) . In the present study it is found that postoperative complications are more in emergency Caesarean group (58%) as against 23% in elective group.…”

“…ACOG recommends the use of a single dose of a narrow spectrum first generation cephalosporin or a single dose of clindamycin with an amino glycoside for those with penicillin allergy, as prophylaxis for Caesarean delivery. (5,10) .Urinary tract infection can be brought down by the policy of avoiding catheterisation as far as possible in primary Caesarean sections. The mean day of suture removal between the two groups did not have any significant difference.…”