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.