When should we perform prophylactic antibiotics in elective cesarean cases?

Objective: The aim of this study was to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal and neonatal infectious morbidity.

Study Design: This was a prospective, randomized trial. Four hundred patients that underwent elective cesarean section between June and December 2007 formed the study population. Eleven patients were excluded from the study because they needed transfusion during the cesarean section. The population was divided into two groups: Group A, antibiotic prophylaxis was applied to 194 women before skin incision and Group B, antibiotic prophylaxis was applied to 195 women after umbilical cord clamping. The occurrence of endomyometritis/endometritis, wound infection, febrile morbidity, total infectious morbidity, and neonatal complications were compared.

Results: There were 389 patients enrolled. No demographic differences were observed between groups. No significant difference was found between the groups for total infectious morbidity [relative risk (RR) 1.39, 95% confidence interval (CI) 0.71-2.69] and endometritis (RR 1.40, 95% CI 0.43-4.51). There was no increase in neonatal sepsis (RR 1.47, 95% CI 0.61-3.53), sepsis workup (RR 1.35, 95% CI 0.75-2.42), need for neonatal intensive care (RR 1.77, 95% CI 0.51-6.16), and intensive care stay period (P = 0.16).

Conclusions: Time of antibiotic prophylaxis application does not change maternal infectious morbidity in cesarean section deliveries. Preoperative prophylaxis application does not affect neonate morbidity rates as stated in literature.