Identification and Management of Women at High Risk for Pelvic Infection Following Cesarean Section

Palma, R. T. de; Leveno, Kenneth J.; Cunningham, F. Gary; Pope, Thomas; Kappus, S.; Roark, Micki; Nobles, B. J.

doi:10.1097/00006250-198003001-00047

Cited by 45 publications

(5 citation statements)

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“…In this study, the reduction in infectious morbidity in each of the groups was significantly better than the 27 to 86% incidence reported in the literature for patients not receiving prophylaxis (3,9). There was no significant difference between the three groups in the incidence of immediate or delayed infectious morbidity.…”

Section: Discussioncontrasting

confidence: 55%

Choice of antibiotic in nonelective cesarean section

Hager

Rapp

Billeter

et al. 1991

Antimicrob Agents Chemother

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The use of antibiotics for prophylaxis against infection among women undergoing nonelective cesarean section has become the standard of care in the United States. Many different antibiotics have been used successfully. Single-dose regimens administered after the cord is clamped have proven just as effective as multiple-dose regimens. Although the most frequently used class of antibiotics is the cephalosporin family, the single best agent has not been determined. This study was a double-blind, randomized trial in which we compared a narrow-spectrum cephalosporin (cefazolin; n = 63) with an expanded-spectrum cephamycin (cefoxitin; n = 66) and with a broad-spectrum cephalosporin (cefotaxime; n = 60) used as a single-dose prophylaxis in patients undergoing a nonelective cesarean section. Of the 194 patients enrolled in the study, 189 were evaluable. There was no significant difference between the groups in mean age, gravidity, parity, duration of labor, duration of ruptured membranes, number of vaginal examinations, or socioeconomic status (socioeconomic status was defined by third-party coverage). There was no significant difference among the antibiotics in the incidence of immediate or delayed postoperative infections. These data indicate that a less expensive, narrow-spectrum cephalosporin is as effective as more expensive, broader-spectrum cephamycins and cephalosporins as prophylaxis for patients undergoing nonelective cesarean section.

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Section: Discussioncontrasting

confidence: 55%

Choice of antibiotic in nonelective cesarean section

Hager

Rapp

Billeter

et al. 1991

Antimicrob Agents Chemother

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“…Ampicillin or gentamycin given prior to cesarean section in women with intrauterine infection, to measure transplacental transfer. No control group, and no clinical outcomes given De Palma 1980 Women at high risk (membranes ruptured for more than 6 hours) initially were randomized to early treatment (ie prophylactic therapy continued for 4 days) vs standard treatment (i.e. treatment only started when infection apparent).…”

Section: Creatsas 1980mentioning

confidence: 99%

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Smaill

Grivell

2014

Cochrane Database of Systematic Reviews

211

159

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The conclusions of this review support the recommendation that prophylactic antibiotics should be routinely administered to all women undergoing cesarean section to prevent infection. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection, endometritis and serious infectious complications by 60% to 70%. There were few data on adverse effects and no information on the effect of antibiotics on the baby, making the assessment of overall benefits and harms difficult. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is beneficial for women but there is uncertainty about the consequences for the baby.

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“…Postpartum endomyometritis after cesarean delivery is common with quoted rates up to 10% even with antibiotic prophylaxis (4). These include abdominal wound infections, broad ligament cellulitis, parametrial phlegmon, septic pelvic thrombophlebitis, intraabdominal abscesses, peritonitis, and uterine incisional necrosis (9,10). However, approximately 10% to 15% of women with puerperal infections have complications resistant to antibiotics.…”

mentioning

confidence: 99%