ObGyn Intelligence
Evidence Matters
Prepare
Evidence LibraryCesarean deliveryThe procedure
Evidence Library · The procedure

Antibiotics before the cut, not after

Timing matters, and so does a second antibiotic in labor.

Antibiotics given before the skin incision rather than after the cord is clamped reduce infection substantially. In a review of 10 trials and 5,041 women, pre-incision antibiotics reduced overall maternal infection (relative risk 0.57), uterine infection (relative risk 0.54) and wound infection (relative risk 0.59), with no increase in newborn sepsis. That review reports these as proportional reductions and does not give pooled absolute rates, so read them as a fraction taken off whatever your own hospital's baseline infection rate is.

For a cesarean performed during labor or after membranes rupture, adding azithromycin cuts infection roughly in half. In a randomized trial of 2,013 women, infection occurred in 6.1% with azithromycin and 12.0% with placebo.

Chlorhexidine skin preparation lowers wound infection compared with iodine: 4.0% versus 7.3% in a randomized trial of 1,147 women.

Where this comes from:
301. Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev. 2014;(12):CD009516.
302. Tita ATN, Szychowski JM, Boggess K, et al. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med. 2016;375(13):1231-1241.
303. Tuuli MG, Liu J, Stout MJ, et al. A randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med. 2016;374(7):647-655.

Covered in the essential classes

Continue

More from The operation

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.