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Antibiotics Before Cesarean?

ACOG has issued recommendations that all women scheduled for cesareans be given antibiotics an hour beforehand and “emergent cases” should be started on antibiotics “as soon as possible.” According to Medpage Today:

Although antimicrobial prophylaxis to reduce postoperative maternal infections is already common practice for C-sections, clinicians need to stop waiting until after clamping the umbilical cord to administer them, according to the statement.

According to ACOG, research shows the following benefits:

*  Fewer wound infections (0.6% when given two hours before skin incision versus 1.4% within three hours after incision)
* Significantly lower endometriosis rates (1% when given 15 to 60 minutes before C-section versus 5% after clamping in one trial and 7.8% when given at incision versus 14.8% after clamping in another)
* Significantly lower total postoperative infection rates (4.5% when given 15 to 60 minutes before C-section versus 11.5% after clamping)

Although an additional small randomized trial showed no significant maternal benefit from preoperative antibiotics, it showed no harm.

The statement published by ACOG dismisses concerns about detrimental effects on the baby if antibiotics are given before the umbilical cord is clamped:

Concerns that exposure could have a negative impact on the baby by masking positive bacterial culture results or leading to antibiotic resistant infections are unfounded, the committee concluded.

Randomized trials have shown no difference in rates of neonatal sepsis overall or from resistant organisms or in rate of admission to a neonatal intensive care unit, although all were underpowered to analyze these secondary outcome measures.

In light of these recommendations, birthing women should discuss their concerns and wishes regarding antibiotics given before a cesarean with their care providers.

3 Comments

  1. Pam says:

    Endometriosis or endometritis? I don’t think antibiotics can prevent endometriosis…

  2. Kelly says:

    I thought the same as Pam.

    Not sure how I feel about this. If they can reduce the risk of infection, then great, but not if it’s at the expense of babies-and doesn’t that last bit from ACOG pretty much say that although they’re claiming no increased risk to babies, the study wasn’t really equipped to assess that? And I can think of an EVEN BETTER way to cut down on those infections, if that’s their goal!

  3. Jenn Riedy says:

    I wonder if this recommendation will result in “failure to progress” cesareans dropping, particularly ones that are called after the “magical” 2 hours of pushing have been completed? If the antibiotics are supposed to be on board for an hour prior to doing the cesarean, it would seem that either doctors are going to have to either start pushing antibiotics sooner than they would normally call “Failure to Progress,” or they might find women end up progressing during that hour they wait for antibiotics.

    I am hopeful that this antibiotic recommendation will slow down the “decision to incision” time in the “emergent” cesareans that are not “emergencies.” I hope (perhaps naively?) that the pause will allow some women to end up birthing vaginally who would have otherwise had cesareans. But also I hope that it will allow women a bit more time to “process” the decision than they are currently given. The flurry of activity that often happens when a failure to progress cesarean is called typically frustrates me as a doula, because I don’t think my clients get enough time to really think about whether it is the option they truly want.