Indication For Elective Caesarean Section Research Articles

Maternal and Fetal Outcome in Emergency versus Elective Caesarean Section.

Caesarean section is one of the most performed surgical procedures all over the world. It is associated with high morbidity and mortality as compared to vaginal delivery. The present study was carried out to evaluate the maternal and neonatal outcome and complications in two groups of pregnant women who underwent elective and emergency cesarean section, so that measures can be taken to reduce morbidity and mortality in near future. It was hospital based descriptive cross-sectional study carried out at Paropakar Maternity and Women's Hospital from October to December 2018. There were 340 patients enrolled in the study 170 in elective and 170 in emergency caesareans selected randomly. Ethical approval was obtained from the Institutional Review Board and informed consent was taken from the patients and patients' guardians. Data were collected daily from the Operation Theater. The rate of caesarean section in the hospital was 30.7%. Proportion of emergency caesarean section was 1324 (74.4%) and elective caesarean section was 456 (25.6%). Emergency Caesarean section was more common in younger age group and in primigravida while elective Caesarean section was more common in advanced age group and in multigravida. The most common indication for emergency Caesarean section was Fetal Distress and the most common indication for elective Caesarean section was previous cesarean with refused vaginal delivery after cesarean section. The maternal outcome in terms of post-operative wound infection, (post-partum hemorrhage, urinary tract infection need for blood transfusion, fever and need for maternal intensive care unit admission was significantly (p- value 0.05) higher in emergency Caesarean section than in elective Caesarean section .The fetal outcome in terms of birth asphyxia, meconium stained liquor and need for Neonatal ICU admission were significantly (p - value 0.05) higher in emergency Caesarean section than in elective Caesarean section. Maternal and fetal complications were significantly higher in the emergency caesarean section as compared to elective caesarean section group.

P611 Provision of care for pregnant women with IBD in the UK - the current landscape

Abstract Background inflammatory bowel disease (IBD) results in increased rates of negative pregnancy outcomes; particularly in poorly controlled disease. We aimed to describe the current landscape of provision of antenatal care for women with IBD in the UK. Methods This cross-sectional study collected data on service set-up, on principles of care pre, during, and after pregnancy and on perceived responsibilities of clinicians. An online survey was distributed to all gastroenterology units in the UK. Results Data were provided for 97 of 273 IBD units. Pre-pregnancy counselling was not available in 7%, offered routinely (39%), or on request (54%) but predominantly (91%) in an ad-hoc fashion rather than in a dedicated set-up. Ninety-two per cent of units provided a nominated gastroenterology consultant during pregnancy. In 86% of this was the patient’s usual consultant rather than a consultant with expertise in pregnancy (14%). Combined clinics with obstetricians and gastroenterologists were offered in 14% of units only, but more often in academic rather than district hospitals (24% vs. 7%; p = 0.043) Otherwise, communication with obstetrics was ‘as and when required’ in 51% of cases. Patients were reviewed either every trimester (55%), monthly (15%) or ‘only when required’ (30%). The majority of respondents thought gastroenterologists should be involved in decisions regarding routine vaccinations (70%), breastfeeding (80%), folic acid dosage (61%), and VTE prophylaxis (53%). Sixty-five per cent of participants thought that gastroenterologists should be involved in decision-making regarding the delivery method. Regarding IBD indications for elective caesarean section, 94% of participants recommended these for active peri-anal disease, 30% for previous but healed peri-anal disease, 56% for ileo-anal pouch and 20% for previous abdominal and/or pelvic surgery. Conclusion In a nationwide survey on the provision of antenatal IBD care we found considerable variation in all aspects of service provision, particularly the availability of expertise and specialist services. We have detected areas of poor care (review only when required, communication ad-hoc only, poor provision of dedicated pre-pregnancy counselling). A significant minority of IBD units also felt that they do not need to provide input into areas such as VTE prophylaxis, delivery method and folic acid dosing. IBD indications for caesarean section seem to be poorly understood by a sizable minority. A basic framework to inform service set-up, and better education on the available clinical guidance for clinicians, is required to ensure consistent identification and review of patients and high-quality care.

A Six-Year Review of Caesarean Sections at the Federal Teaching Hospital Abakaliki, Ebonyi State, South East Nigeria

Background: Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). Subjects and Methods: This was a six-year retrospective study covering January 1st 2012 to December 31st 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed by means of Epi Info version 7. Results are presented in tables, means and simple percentages. Results: During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. The most common indication for an emergency caesarean section was failure to progress in labour with 20.0% contribution and the most common indication for elective caesarean section was previous caesarean section with 13.5%. Majority of the babies were delivered at term (77.0%) with an average gestational age of 38 ± 2.6 weeks. Almost two-thirds of the subjects (62.5%) had emergency caesarean section. The average birthweight was 3.03 ± 0.71 kg. Maternal anaemia was the most common complication recorded 38.0%. There was direct maternal death in 2.0% of the study population. Severe birth asphyxia was recorded in 12.3% of the babies while there was 3.2% perinatal death. Conclusion: There is a high rate of caesarean section from this study. The World Health Organization has stated that there is no additional maternal or fetal benefit with caesarean section rate of greater than 10% - 15%. Stakeholders and policy makers need to do more to mitigate this rising trend.

Pilot randomised controlled trial comparing the risk of neonatal respiratory distress in elective caesarean section at 38 weeks’ gestation following a course of corticosteroids versus caesarean at 39 weeks

IntroductionThe objective of this study was to compare neonatal respiratory morbidity and rate of emergency caesarean section between elective caesarean sections at 38 gestational weeks following a course of corticosteroids and planned caesarean sections at 39 gestational weeks. Material and methodsThis was a multicentre randomised controlled trial. The study was conducted between 2007 and 2013 in level 2 and 3 maternity units in France. A total of 208 women with an indication for elective caesarean section were enrolled and 200 analysed in per-protocol analysis. Women were randomised to either elective caesarean section at 38 gestational weeks after a course of corticosteroids (trial group) or elective caesarean section at 39 weeks (control group). The primary outcome was the rate of admission to the neonatal intensive care unit for respiratory distress. ResultsTwo (2.1%) newborn in the tested group were admitted because of respiratory distress versus four (3.8%) in the control group. The relative risk was 0.54 in favour of the corticosteroid group (95% CI: 0.10; 2.86). There were fewer emergency caesareans in the trial group than in the control group: 12 (12.69%) versus 28 (26.67%), p=0.01. ConclusionsOur study suggests that planning caesarean sections at 38 gestational weeks after a course of corticosteroids would enable a significant reduction in the number of emergency caesareans without increasing the risk of neonatal respiratory distress. Limitations of this study include difficulties in patient recruitment and the small number of subjects.

Clinicians' Perspectives and Experiences Regarding Maternity Care in Women With Vulvodynia.

To assess clinicians' frequency of and comfort with provision of maternity care for women with vulvodynia, their beliefs and practices regarding delivery mode, and frequency of maternal requests for Caesarean section (CS). We invited physicians and midwives to complete a questionnaire assessing their frequency of contact with pregnant women with vulvodynia; their level of comfort providing antenatal, intrapartum, and postpartum care for these women; whether they believed that vulvodynia is an indication for elective CS and the frequency of making this recommendation; and the number of patients with vulvodynia who strongly requested CS. Of the 140 participating clinicians, 91 were physicians and 49 were midwives. Most physicians (n= 64; 70.4%) saw patients with vulvodynia at least once per month. Clinicians who saw women with vulvodynia were most likely to see pregnant women with vulvodynia rarely (n= 54; 40.3%) or every six to 12 months (n= 29; 21.6%). Almost one third (n= 44; 31.4%) were not comfortable providing maternity care for these women, and 16.4% (n= 23) agreed that vulvodynia was an indication for elective CS. Of respondents who provided maternity care for women with vulvodynia, 15.4% (n= 18) had recommended CS; the most common reason for doing so was potential worsening of vulvar symptoms. The majority of clinicians who provided maternity care for women with vulvodynia (n= 73; 62.4%) indicated that maternal requests for CS were rare. Almost one third of participating clinicians (31.4%) were not comfortable providing maternity care for women with vulvodynia. Despite infrequent maternal requests, a minority of clinicians believed that vulvodynia is an indication for CS and/or made that recommendation. Additional research and education are needed to provide optimal obstetric care for women with vulvodynia.

Pronostic obstétrical des présentations podaliques à terme en cas de rupture des membranes avant travail

Breech delivery is still a controversial situation in literature. Added complexity exists when breech presentations are associated with premature rupture of membranes (PROM) as such cases are conventionally excluded in studies dealing with PROM and are often indications for elective caesarean section. Thus, the objective of this study was to evaluate the obstetrical prognosis of breech presentations after PROM at term. We conducted a retrospective observational study at the Besançon University Medical Centre, between 1(st) January 2008 and 31(th) December 2012. Two groups of patients with breech presentations at term were constituted according to the existence or not of a PROM. The primary endpoint was the delivery mode: caesarean section or vaginal. Other endpoints were maternal characteristics, type of onset of labour and neonatal criterias. Two hundred and nine patients were included. In the control group, 67.9 % of vaginal deliveries occurred versus 60 % in the group with PROM (P=0.25). No difference was found on neonatal criterias such as pH, lactate and the Apgar score at 5 minutes. PROM at term in breech presentation doesn't seem to change the obstetrical prognosis and should therefore not be a systematic indication for elective caesarean section.

Caesarean section and perinatal outcomes in a sub-urban tertiary hospital in North-West Nigeria.

Objectives:This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1st January 2010 to 31st December, 2012.Materials and Methods:This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit (ICU) and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1st January 2010 to 31st December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analysed using SPSS version 17.0 statistical software (Chicago, Il, USA). Absolute numbers and simple percentages were used to describe categorical variables. Association between caesarean section and perinatal mortality was determined using Pearson's Coefficient of correlation and student t- test. P - value < 0.05 was considered statistically significant.Result:This study reported a caesarean section rate of 17.69 % and a perinatal mortality rate of 165.6 per 1000. Majority of the babies (78.2%) were within normal weight. The mean age of the women was 25.9 ± 6.2 years and mean parity was 4 ± 3. Majority of them were uneducated and unemployed. Obstructed labour was the commonest indication for emergency caesarean section accounting for 31.7% of caesarean sections and foetal distress was the least at 2.6 %. Two or more previous caesarean section was the commonest indication for elective caesarean section (17.1%) and bad obstetrics history the least indication (1.4%). There is a weak positive correlation (r = 0.35) between caesarean section rate and perinatal mortality and this association was not statistically significant (P = 0.12).Conclusion:Caesarean section and perinatal mortality rates in the present study are comparatively high. Absence of significant correlation means that a high caesarean section rate is not likely to improve perinatal outcomes in babies of normal weight; therefore the caesarean section rate in this centre should be reduced. Measures to reduce perinatal mortality such as skilled attendant in labour and training of medical staff in neonatal resuscitation should be adopted.

Indications for Elective Caesarean Section in IBD: A Population-based Study

Indications for Elective Caesarean Section in IBD: A Population-based Study

Childbirth with fetal pelvis presentatio: Challenge in modern obstetrics

The aim was to determine the incidence of fetal breech presentation at term, the factors that determine how the impact of labor and mode of delivery on neonatal outcome in pregnancies with a fetus in breech presentation pelvic presentation is a form of the longitudinal position of the fetus, which leads the pelvis and occurs in approximately 3% of pregnancies. Numerous studies have shown contradictory results regarding the optimal mode of delivery in breech presentation of fetus. A retrospective study at the Hospital of Gynecology and Obstetrics, University Hospital Zemun-Belgrade in the period 01.01.2009-31.12.2011 year. We analyzed data obtained from the delivery protocol, computer databases and annual reports. Study involved 111 pregnant women in the forward singleton pregnancy (37-41 weeks gestation) with fetal pelvis. We analyzed and compared the group of patients who delivered their babies vaginally and the group of patients who delivered their babies by caesarean section (emergency and planned). Analyzed and compared the following parameters: maternal age, parity, gestational age trudnoće, premature rupture of membranes, weight and head circumference fetus at birth, Apgar score and neonatal complications. The data were analyzed by descriptive and analytical statistics. Results are presented tables and graphs. The study period was performed 4665 deliveries, with 111 deliveries in futures fetuses in breech presentation, which is 2.4%. Women delivered vaginally was 79(71%), emergency caesarean section 17(15%), a planned caesarean section 15(14%) pregnant women. The study showed a statistically significant difference in parity (C2=6.23 p<0, 05), with greater participation in the group of primiparas cesarean section, gestational age (t=5.23 p<0,01), weight and head circumference (t=4.37, t=2.47 p<0,01), premature rupture of membranes, (C2=7.72 p<0,01) and gender structure (C2=4.03 p<0,05). The most common indication for elective Caesarean section was prolonged pregnancy, and for an emergency cesarean section because of the delivery routes. There was no statistically significant difference in age of the mother t=1.08, p>0,05, the values of Apgar score in 5 minutes t=1.67 p>0,05, neurological changes p=0.292 and birth trauma, p=0.292 between two groups of neonates. The values of ul minute Apgar score were at the limits of statistical significance p=1.97 p≥0.05. Vaginal delivery in breech presentation, fetal, obstetric an acceptable range, while respecting the principles of good obstetric practice, there is no increase in neonatal morbidity.

The course of pregnancy and childbirth in three mothers with recessive dystrophic epidermolysis bullosa

Recessive dystrophic epidermolysis bullosa (RDEB) is an autosomal recessive skin disease caused by mutations in the type VII collagen gene (COL7A1), resulting in detachment of the entire epidermis due to loss or hypoplasticity of the anchoring fibrils that normally secure the basement membrane to the underlying dermis. Trauma-induced blistering is often complicated by chronic erosions and scarring. From that perspective, pregnancy in RDEB might be considered an indication for elective caesarean section in a bid to minimize perineal blistering. To date, only four cases of pregnancy and delivery in patients with RDEB have been reported. We report three more women, each with RDEB-generalized other (RDEB-GO), all of whom had successful vaginal deliveries without major cutaneous or mucosal complications. One woman also had a second child, by vaginal delivery, indicating a lack of vaginal stenosis after the first birth. These cases show that RDEB-GO is not an absolute primary indication for elective caesarean section and that, perhaps surprisingly, genital/perineal blistering and scarring are not inevitable consequences of childbirth. Moreover, breastfeeding is also feasible in women with RDEB-GO.

Is routine cervical dilatation necessary during elective caesarean section? A randomised controlled trial

The purpose of this prospective randomised study was to determine the effect of routine cervical dilatation during elective caesarean section on maternal morbidity. Participants with indication for elective caesarean section were randomly allocated to two groups. Group A (n = 200) women with intraoperative cervical dilatation; group B (n = 200) women with no intraoperative cervical dilatation. No demographic differences were observed between groups. There was no significant difference between groups in infectious morbidity (P = 0.87) (relative risk (RR) 1.11, 95% confidence interval (CI) 0.58-2.11), endometritis (P = 0.72) (RR 1.68, 95% CI 0.39-7.14), febrile morbidity (P = 0.66) (RR 1.21, 95% CI 0.51-2.87), wound infection (P = 0.82) (RR 1.11, 95% CI 0.44-2.81), endometritis (P = 0.72) (RR 1.68, 95% CI 0.39-7.14) or urinary tract infection (P = 1.00) (RR 1.00, 95% CI 0.28-3.50), and estimated blood loss (P = 0.2). However, group A had longer operative times compared with the group B (P = 0.01). Intraoperative digital cervical dilatation during elective caesarean section did not reduce blood loss and postoperative infectious morbidity. The routine digital cervical dilatation during elective caesarean section is not recommended.

Elective caesarean section at the Federal Medical Centre Makurdi, North Central Nigeria

Elective caesarean section is associated with less risk of adverse events compared to emergency caesarean section. Paradoxically, emergency caesarean deliveries continue to form the bulk of caesarean deliveries in our facility. The aim of this study is to determine the caesarean section rate, ascertain the trend of elective caesarean section, indications for elective caesarean section and elective caesarean mortality. A retrospective analysis of the clinical records of all patients that had caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi was conducted. There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5%. The elective caesarean sections accounted for 69(16.4%) while emergency caesarean sections accounted for 351(83.6%) of all caesarean sections. The rate of elective caesarean section increased from 10.3% in 2004 to 22.8% in 2006 of all caesarean sections. Two or more previous caesarean sections were the commonest indication for elective caesarean section accounting for 23.2% of cases, followed by HIV infection in pregnancy accounting for 21.7% of cases. No maternal death occurred with elective caesarean section. There is a rising trend of elective caesarean section presently accounting for 1 out of every 6 caesarean sections in the centre. The commonest indication for elective caesarean section was two or more caesarean sections, followed by retroviral disease in pregnancy. Elective caesarean section remains safer than emergency caesarean section in our facility.

Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study

Objective: In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33–35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group.Methods: A total of 240 women at 33–35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupoint (Zhiyin). The primary outcome of the study was fetal presentation at delivery.Results: Fourteen cases dropped out. The final analysis was thus made on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active-treatment group (53.6%) (p = 0.01). Hence, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% vs. 66.7%, p = 0.03).Conclusions: Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.

The effects of labour and delivery on the pelvic floor

Increasing public and professional attention has recently been focused on the issue of both faecal and urinary incontinence following childbirth and these symptoms are sometimes being cited as indications for elective caesarean section. Faecal incontinence has a female-to-male preponderance of 8:1, consistent with childbirth as the principal causative factor, although most symptomatic women do not seek medical advice until after the menopause. Similarly, urinary stress incontinence is almost an exclusively female phenomenon. Obstetric injury may take the form of direct muscular damage to the anal sphincter, as occurs during a third-degree tear, and/or may be the result of cumulative damage to the pudendal nerves. Mechanical, neural and endocrine factors may all play a causative role in faecal incontinence. Symptoms are rarely volunteered by the patient, and may be present for many years after the index pregnancy, and clinical examination alone may fail to detect specific abnormalities. The performance of anal manometry, endoanal ultrasound, urodynamics and neurophysiology studies of the pelvic floor may help to increase the diagnostic yield. Treatment for both urinary and faecal incontinence is available in the form of physiotherapy, fluid and dietary manipulation and in more severe cases, surgery. Adequate primary management of third-degree tears requires careful appraisal as this injury, in particular, is the most important risk factor for subsequent faecal incontinence symptoms.In this chapter we aim to outline the mechanism of damage to the pelvic floor during childbirth, concentrating primarily on anal sphincter damage. We describe the necessary investigations, follow-up and treatment which women with significant pelvic floor damage should receive following delivery, and we finally discuss the issue of further deliveries and, specifically, the current place of caesarean section.

Patient Preference the Leading Indication for Elective Caesarean Section in Public Patients—Results of a 2-Year Prospective Audit in a Teaching Hospital

Because the rate of cesarean delivery has grown markedly in recent decades and recent research indicates that patient requests may be one of the strongest indications, a prospective study was undertaken to audit indications for operative delivery. A total of 9138 deliveries at an Australian teaching hospital in a 2-year period were reviewed. The cesarean delivery rate was 17.8 percent, and of the 1624 caesarean deliveries, 39 percent were elective. More than one fourth of elective cesarean deliveries (27 percent) were done solely because of the mother’s request, and this was the leading indication for elective surgery. In 103 of 170 cases, the woman had previously had a cesarean delivery, but the current pregnancy was otherwise suitable for a trial of labor. All 56 women with breech presentation also were otherwise suitable for attempted vaginal birth. Only five women presented no particular reason for requesting elective delivery. The most common medical indication for elective cesarean delivery was more than one previous cesarean delivery. Other medical indications included a previous complicated cesarean delivery, a term breech presentation in which a trial of labor was considered inadvisable, placenta previa, severe intrauterine growth retardation with abnormal placental function, transverse and unstable fetal lie, suspected cephalopelvic disproportion, and preeclampsia. Preterm breech presentation, active herpes simplex, multiple gestation, and abruptio placenta were other indications. Nonelective cesarean deliveries were most often done because of suspected fetal distress or failure to progress in labor. The investigators believe that current maternal decision-making may well be influenced by the modern emphasis on patient advocacy and consumer choice. Attempts to lower the cesarean delivery rate should focus on promoting a trial of vaginal delivery in cases of a history of past cesarean delivery and also in cases of breech presentation. It also would help to develop better means of detecting fetal acidosis during labor. Aust NZ J Obstet Gynaecol 1999;39:207–214

Obstetric intervention and cerebral palsy

Obstetric intervention and cerebral palsy

Patient preference the leading indication for elective Caesarean section in public patients--results of a 2-year prospective audit in a teaching hospital.

In response to a Western Australian Ministerial enquiry into the levels of intervention in childbirth, a 2-year prospective audit was undertaken of the indication and timing of all public Caesarean section deliveries at King Edward Memorial hospital. During the study period, a total of 9,138 deliveries were performed at the hospital, of which 1,624 were by Caesarean section, an overall rate of 17.8%. Of these, 633 (39%) were elective and 911 (61%) were nonelective. The most common primary indication for elective Caesarean section was maternal choice, largely due to a refusal of the patient to consent to a trial of scar following a single previous Caesarean section or a refusal to attempt a trial of vaginal breech delivery. The most common indications for nonelective Caesarean section birth were an intrapartum diagnosis of suspected fetal distress or failure to progress in labour. Strategies to reduce the incidence of Caesarean section birth need to focus on the pathways involved with maternal decision-making in the birth process, and on improving the diagnosis of intrapartum fetal compromise.

Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity

Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. The aim of this study is to compare the efficacy of single dose versus multiple doses of a first generation cephalosporin (with Metronidazole), to reduce postoperative infectious morbidity in elective caesarean section. It was prospective clinical trial of hundred women undergoing elective caesarean section who received either a single prophylactic dose of Cefazolin with Metronidazole post-cord clamping, or multiple postoperative doses of antibiotics based on the standard protocol of the hospital. Duration of the study was seven months and twenty-two days (11th November 2004 to 30 th June 2005).Women were compared on the basis of development of postoperative febrile morbidity, endometritis, urinary tract infection, wound infection and other infections. There were no significant differences among the patients in single and multiple dose groups in terms of their age distribution, gravida, period of gestation, smoking status, body mass index, indications for elective caesarean section or operation characteristics. There were 4% and 6% febrile morbidity, 2 (4%) and 0 (0%) urinary tract infection, in the single dose and multiple dose groups respectively. But none of the differences were statistically significant. A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section.