Preoperative antibiotics before cesarean delivery significantly reduce postpartum endometritis compared to antibiotics given at cord clamping, but do not affect neonatal outcomes, according to research published in the September issue of the American Journal of Obstetrics & Gynecology.

Maged M. Costantine, MD, of the University of Texas Medical Branch in Galveston, and colleagues performed a meta-analysis summarizing evidence related to perioperative antibiotic delivery during Caesarean sections. The authors searched for randomized controlled trials comparing pre-procedure antibiotics versus prophylactic antibiotics given at cord clamping.

Preoperative delivery of antibiotics significantly decreased the risks of postpartum endometritis and total infectious morbidity with relative risks of 0.47 and 0.50, respectively, the investigators found. However, preoperative delivery of antibiotics did not significantly decrease work-up for suspected neonatal sepsis (RR, 1.0), proven sepsis (RR, 0.93) or neonatal intensive care unit admissions (RR, 1.07). The researchers did not detect heterogeneity among the trials.

“There is strong evidence that antibiotic prophylaxis for Caesarean delivery that is given before skin incision, rather than after cord clamping, decreases the incidence of postpartum endometritis and total infectious morbidities, without affecting neonatal outcomes,” the authors conclude.

Costantine MM, Rahman M, Ghulmiyah L, et al. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol. 2008;199:301.e1-301.e6.

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Preoperative antibiotics before cesarean delivery significantly reduce postpartum endometritis compared to antibiotics given at cord clamping, but do not affect neonatal outcomes, according to research published in the September issue of the American Journal of Obstetrics & Gynecology.