antimicrobial prophylaxis for cesarean delivery: before or after cord clamping?
DESCRIPTION
Swiss Association of Obstetric Anesthesia (SAOA) Fall meeting / SSAR 2011 Interlaken, October 27 th , 2011. Antimicrobial prophylaxis for Cesarean delivery: before or after cord clamping?. Dr Emmanuel Boselli Anesthesiology and Intensive Care Department Édouard Herriot Hospital, HCL - PowerPoint PPT PresentationTRANSCRIPT
Antimicrobial prophylaxis for Cesarean delivery:
before or after cord clamping?Dr Emmanuel Boselli
Anesthesiology and Intensive Care DepartmentÉdouard Herriot Hospital, HCL
Lyon, France
Swiss Association of Obstetric Anesthesia (SAOA)
Fall meeting / SSAR 2011Interlaken, October 27th, 2011
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Cesaeran section
Risk factor for :
– post-partum infection
– maternal morbidity
– length of stay
Post-partum infection
No antimicrobial prophylaxis
Polymicrobial :– Gram + cocci– Gram - bacilli– Anaerobes
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Prevention of infection
Rigorous surgical technique
Skin disinfection
Antimicrobial prophylaxis
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Antimicrobial prophylaxis
infectious complications– endometritis– wound infection– bacteremia or severe infection
length of staySmaill F et al. Cochrane Database Syst Rev 2002;CD000933
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Antimicrobial agent
Single-dose cefazolin (1GC)– as efficient as larger-spectrum agents– as efficient as multiple-doses
Allergy : clindamycin
Hopkins L et al. Cochrane Database Syst Rev 2000;CD001136
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Surgery = before skin incision
Cesarean = after cord clamping– modification of neonatal flora?– risk of neonatal necrotic enterocolitis?
Recent data : better before?
Optimal timing?
Thigpen BD et al. Am J Obstet Gynecol 2005;192:1864–71Sullivan SA et al. Am J Obstet Gynecol 2007;196:455[e1–e5]
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Methods
3 electronic databases • Pubmed• Cochrane • Embase
Period: 1966-2008
Keywords:• antibiotics, antimicrobial• cesarean• prophylactic, prophylaxis
Flow chart
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
201 potential trials
191 RCTs concerning prophylaxis
166 RCTs concerning IV prophylaxis
5 RCTs comparing timing
(n = 1108)
10 exclusions(Non RCTs)
25 exclusions(Non IV prophylaxis)
161 exclusions(Efficacy studies)
Results
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Maternal outcome
Neonatal outcome
Results before vs after cord clamping
Outcome OR [95% CI]
MaternalEndometritis
Wound infectionTotal infectious morbidity
0.59 [0.39-0.98]0.58 [0.29-1.16]0.51 [0.32-0.82]
NeonatalInfection
Suspected sepsisDocumented sepsis
Admission in ICU
1.06 [0.57-1.96]1.02 [0.67-1.54]0.93 [0.43-2.02]0.97 [0.61-1.56]
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Conclusion
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Antimicrobial prophylaxisbefore cord clamping
endometritis
maternal infectious morbidity
No effect on neonatal outcome• Not primary outcome• β-lactams widely used during pregnancy
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Fall meeting / SSAR 2011, Interlaken, October 27th, 2011
Antimicrobial prophylaxis for Cesarean section
before cord clamping:
To be recommended?