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Timing of Antibiotic Prophylaxis in Elective Caesarean Delivery: A Multi-Center Randomized Controlled Trial and Meta-Analysis

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  • Chuan Zhang
  • Lingli Zhang
  • Xinghui Liu
  • Li Zhang
  • Zhiyou Zeng
  • Lin Li
  • Guanjian Liu
  • Hong Jiang

Abstract

Objective: To compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery. Methods: We conducted a randomized open-label controlled trial with two parallel arms at three hospitals in western China. Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others received antibiotics after umbilical cords clamping. For the meta-analysis, studies were identified from the database of PUBMED, Cochrane Library and EMbase and assessed using the Cochrane risk of bias tool. Results: Four hundred and ten patients were randomized to receive antibiotics before skin incision (n = 205) or after umbilical cords clamping (n = 205). There was no difference in the incidence of postpartum endometritis (RR = 0.34, 95% CI 0.04 to 3.24), wound infection (RR = 3.06, 95% CI 0.13 to 74.69) and total puerperal morbidity (RR = 1.02, 95% CI 0.47 to 2.22). No increase in the incidence of neonatal sepsis (RR = 0.34, 95% CI 0.04 to 3.24), septic workup (RR = 0.41, 95% CI 0.08 to 2.07), or intermediate NICU admission (RR = 0.73, 95% CI 0.24 to 2.26) was observed. The meta-analysis involving nine RCTs showed that no statistically significant difference was found in terms of the risk of postpartum endometritis (RR = 0.73, 95% CI 0.39, 1.36), wound infection (RR = 0.80, 95%CI 0.55, 1.17), or puerperal morbidity (RR = 0.89, 95% CI 0.70, 1.13). No increase in the incidence of neonatal sepsis (RR = 0.65, 95% CI 0.35 to 1.20), septic workup (RR = 0.88, 95% CI 0.50 to 1.54), or intermediate NICU admission (RR = 0.91, 95% CI 0.70 to 1.18) was observed. Conclusion: For elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up. Trial Registration: Chinese Clinical Trial Registry ChiCTR-TRC-11001853

Suggested Citation

  • Chuan Zhang & Lingli Zhang & Xinghui Liu & Li Zhang & Zhiyou Zeng & Lin Li & Guanjian Liu & Hong Jiang, 2015. "Timing of Antibiotic Prophylaxis in Elective Caesarean Delivery: A Multi-Center Randomized Controlled Trial and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-15, July.
    • Handle: RePEc:plo:pone00:0129434
    DOI: 10.1371/journal.pone.0129434
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    1. Shokrollah Elahi & James M. Ertelt & Jeremy M. Kinder & Tony T. Jiang & Xuzhe Zhang & Lijun Xin & Vandana Chaturvedi & Beverly S. Strong & Joseph E. Qualls & Kris A. Steinbrecher & Theodosia A. Kalfa , 2013. "Immunosuppressive CD71+ erythroid cells compromise neonatal host defence against infection," Nature, Nature, vol. 504(7478), pages 158-162, December.
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    1. Michael Dias & Allyn Dick & Rebecca M Reynolds & Marius Lahti-Pulkkinen & Fiona C Denison, 2019. "Predictors of surgical site skin infection and clinical outcome at caesarean section in the very severely obese: A retrospective cohort study," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-15, June.

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