Emergent cesarean delivery (CD) carries a high risk for postpartum infection. In cases with a “splash” povidone-iodine (PI) skin preparation, prophylactic postoperative antibiotics (PP-Abx) are sometimes utilized, but the benefit is unclear. We sought to determine if use of PP-Abx decreases postpartum infection after emergent CD with PI skin preparation. Cohort study of women undergoing emergent CD with PI skin preparation from July 2012 to April 2020 at a single institution. Cases were identified using a natural language search engine, DEEP-6, with key terms “emergent” and “cesarean delivery”. Women with chorioamnionitis or non-PI skin preparation (e.g., chlorhexidine) were excluded. The primary exposure was use of PP-Abx. The primary outcome was postpartum infection, defined as a composite: endometritis, wound infection, cellulitis, seroma, hematoma, or intra-abdominal abscess. Rates of postpartum infection were stratified by use of PP-Abx. Demographic and labor characteristics were evaluated as confounders. Statistics by χ2, t-test and logistic regression (α=0.05). In total, 489 women underwent emergent CD; of those, 370 had PI skin preparation and were included. PP-Abx were given in 43% (160/370) of cases, including: cefazolin (n=137), gentamicin/clindamycin (n=18), azithromycin (n=3), and vancomycin (n=2). Those receiving PP-Abx were similar to those who did not, except the PP-Abx group was younger with longer CD duration (Table 1). The rate of postpartum infection was no different in women who received PP-Abx compared to those who did not (12.6% vs 9.5%, P=0.34) (Table 2). This finding remained unchanged after multivariable adjustment (aOR 1.2, CI 0.61-2.4, P=0.60). Moreover, the rate of postpartum infection did not vary by antibiotic choice. After emergent CD with PI skin preparation, routine use of prophylactic postoperative antibiotics does not appear to reduce the rate of postpartum infection, which is important as we consider antibiotic stewardship. More studies are needed to identify treatments that decrease infectious morbidity with emergent CD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)