Administration of Cefazolin Prior to Skin Incision is Superior to Cefazolin at Cord Clamping

view Dr. Sullivan's video:  The Proper Timing of Prophylactic Antibiotics for Caesarian Section

Abstract

Objective: The objective of this study was to determine whether the administration of Cefazolin prior to skin incision was superior to administration at the time of umbilical cord clamping for the prevention of post-cesarean infectious morbidity.

Study Design: This was a prospective, randomized, double-blind placebo-controlled trial. Study subjects received 1 gram of Cefazolin at least 15 minutes prior to skin incision. Control subjects received the same antibiotic at the time of cord clamping. Subjects were followed for the occurrence of endomyometritis, wound infection and other infectious morbidity. Neonatal outcomes were collected for occurrence of sepsis, septic workups and length of stay.

Results: 367 subjects were enrolled in the trial and 357 completed follow up. There were no demographic differences observed between the study and control groups including age (p = 0.87), race (p = 0.8) or insurance (p = 0.86). There were no differences seen in clinical variables between groups including diabetes (p = 0.1), weight (p = 0.49) or indication for cesarean. There was decreased total infectious morbidity in the study group [RR = 0.4, 95 % CL 0.18-0.87], decreased endometritis [RR = 0.2 95 % CL 0.15-0.94] and a trend toward decreased wound infections [RR = 0.52 95 % CL 0.18-1.5]. No increase in neonatal sepsis (p = 0.90), sepsis workups (p = 0.87) or admission days (p = 0.2) was observed in the study group.

Conclusion: Administration of prophylactic Cefazolin prior to skin incision resulted in a decrease in both endomyometritis and total post-cesarean infectious morbidity compared to administration of the same dose at the time of cord clamping. This dosing did not result in increased neonatal sepsis, septic workup or admission days.

References:

0002-9378/$ - see front matter

doi:10.1016/j.ajog.2006.10.043

American Journal of Obstetrics and Gynecology

Volume 195, Issue 6, Supplement S (December 2006)