Abstract
ObjectiveTo compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery.MethodsWe conducted a randomized open-label controlled trial with two parallel arms at three hospitals in western China. Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others received antibiotics after umbilical cords clamping. For the meta-analysis, studies were identified from the database of PUBMED, Cochrane Library and EMbase and assessed using the Cochrane risk of bias tool.ResultsFour hundred and ten patients were randomized to receive antibiotics before skin incision (n = 205) or after umbilical cords clamping (n = 205). There was no difference in the incidence of postpartum endometritis (RR = 0.34, 95% CI 0.04 to 3.24), wound infection (RR = 3.06, 95% CI 0.13 to 74.69) and total puerperal morbidity (RR = 1.02, 95% CI 0.47 to 2.22). No increase in the incidence of neonatal sepsis (RR = 0.34, 95% CI 0.04 to 3.24), septic workup (RR = 0.41, 95% CI 0.08 to 2.07), or intermediate NICU admission (RR = 0.73, 95% CI 0.24 to 2.26) was observed. The meta-analysis involving nine RCTs showed that no statistically significant difference was found in terms of the risk of postpartum endometritis (RR = 0.73, 95% CI 0.39, 1.36), wound infection (RR = 0.80, 95%CI 0.55, 1.17), or puerperal morbidity (RR = 0.89, 95% CI 0.70, 1.13). No increase in the incidence of neonatal sepsis (RR = 0.65, 95% CI 0.35 to 1.20), septic workup (RR = 0.88, 95% CI 0.50 to 1.54), or intermediate NICU admission (RR = 0.91, 95% CI 0.70 to 1.18) was observed.ConclusionFor elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up.Trial RegistrationChinese Clinical Trial Registry ChiCTR-TRC-11001853
Highlights
China had the highest overall incidence of caesarean delivery (CD) in Asia according to the WHO Global Survey On Maternal And Perinatal Health 2007–08 [1]
Timing of Antibiotic Prophylaxis in Elective Caesarean Delivery morbidity (RR = 0.89, 95% CI 0.70, 1.13)
The effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery
Summary
China had the highest overall incidence of caesarean delivery (CD) in Asia according to the WHO Global Survey On Maternal And Perinatal Health 2007–08 [1]. Ministry of Health of the People's Republic of China has appealed to reduce the incidence of CD and they are exploring ways to decrease the risk of CD. Infections, such as endometritis and wound infections, were the most common complications in CD. Ministry of Health of China, in contrast to other countries, recommended antibiotic prophylaxis after cord clamping in CD instead of that before skin incision due to lack of evidence from trials in Chinese
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