Although current guidelines for antibiotic prophylaxis recommend the administration of narrow-spectrum antibiotics ( cefazolin ) after clamping of the umbilical cord , the data suggest that antibiotic administration before surgical incision or the use of extended-spectrum regimens ( involving azithromycin or metronidazole ) after cord clamp may reduce postcesarean maternal infection by up to 50 % .
: The use of either cefazolin alone before surgical incision or an extended-spectrum regimen after cord clamp seems to be associated with a reduction in  postcesarean maternal infection .
Randomized Clinical Trial of Extended Spectrum Antibiotic Prophylaxis With Coverage for Ureaplasma urealyticum to Reduce Post–Cesarean Delivery Endometritis
OBJECTIVE To determine if extended spectrum prophylactic antibiotic treatment ( with efficacy against Ureaplasma urealyticum ) reduces post – cesarean delivery clinical endometritis . METHODS After cord clamping at cesarean delivery , subjects received prophylaxis with cefotetan . Subjects were then simultaneously r and omized ( double blind ) to receive doxycyline plus azithromycin versus placebo .  Post – cesarean delivery endometritis was defined clinical ly as fever of 100.4F or higher with one or more supporting clinical signs or a physician diagnosis of endometritis plus the absence of a nonpelvic source of fever . RESULTS A total of 597 women were enrolled , 301 in the doxycycline/azithromycin group and 296 in the placebo group . The study population was 56 % black , 25.5 ± 6.2 years of age , and 43 % nulliparous . The groups were similar ( P > .05 ) for black race , parity , maternal age , and most risk factors for post – cesarean delivery endometritis . The frequency of post – cesarean delivery endometritis ( 16.9 % versus 24.7 % , P = .020 ) , wound infections ( 0.8 % versus 3.6 % , P = .030 ) , and a combination of these two outcomes ( 19.0 % versus 27.8 % , P = .019 ) were significantly lower in the doxycycline/azithromycin group compared with the placebo-treated group . The doxycycline/azithromycin versus placebo groups were dissimilar for maternal leukocytosis ( 24.9 % versus 12.5 % , P = .042 ) and frequency of classic uterine incision ( 7.6 % versus 12.5 % , P = .048 ) . Adjusting for these factors did not alter the risk ratio for post – cesarean delivery endometritis in the active versus placebo-treated group ( relative risk 0.65 , 95 % confidence interval 0.43 , 0.98 ) . Length of stay was longer in the placebo group overall ( 104 ± 56 versus 95 ± 32 hours , P = .016 ) and among women with endometritis ( 146 ± 52 versus 127 ± 46 hours , P = .047 ) . CONCLUSION Extended spectrum prophylactic antibiotic treatment ( with presumed efficacy against U urealyticum ) given to women undergoing cesarean delivery at term shortens hospital stay and reduces the frequency of post – cesarean delivery endometritis and wound infections
Although current guidelines for antibiotic prophylaxis recommend the administration of narrow-spectrum antibiotics ( cefazolin ) after clamping of the umbilical cord , the data suggest that antibiotic administration before surgical incision or the use of extended-spectrum regimens ( involving azithromycin or metronidazole ) after cord clamp may reduce postcesarean maternal infection by up to 50 % .
: The use of either cefazolin alone before surgical incision or an extended-spectrum regimen after cord clamp seems to be associated with a reduction in  postcesarean maternal infection .