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 .
Decreasing Incidence of Postcesarean Endometritis With Extended-Spectrum Antibiotic Prophylaxis
OBJECTIVE : To describe the effect of an extended-spectrum prophylactic antibiotic regimen on  postcesarean endometritis .  METHODS : This is a cohort study of trends in  postcesarean endometritis  using data both from prospect i ve surveillance by the infection control unit and from query of our obstetric computerized data base to compare three periods of antibiotic prophylaxis : st and ard narrow-spectrum with intravenous first- or second-generation cephalosporin ( 1992–1996 ) , clinical trial of extended-spectrum with addition of intravenous doxycycline and oral azithromycin ( 1997–1999 ) , and routine use of extended-spectrum with addition of intravenous azithromycin ( 2001–2006 ) to st and ard cephalosporin prophylaxis . RESULTS : A total of 48,913 deliveries at 24 weeks or more of gestation occurred from 1992 to 2006 , of which 10,966 ( 22.4 % ) were cesarean deliveries . Annual cesarean rates increased from 16 % to 27.5 % . Trends in the incidence of postcesarean endometritis revealed a biphasic decrease consistent with the phased introduction of extended-spectrum prophylaxis . Incidence ( 95 % confidence interval [ CI ] ) of endometritis by prospect i ve surveillance dropped from 19.9 % ( 95 % CI 18.6–21.3 % ) to 15.4 % ( 95 % CI 13.2–17.9 % ) during the clinical trial period : relative risk ( RR ) 0.77 ( 95 % CI 0.66–0.91 ) , P=.002 ; and then to 6.3 % ( 95 % CI 5.0–7.9 % ) during routine use of extended-spectrum prophylaxis : RR 0.41 ( 95 % CI 0.31–0.54 ) , P<.001 . Corresponding incidence by data base query dropped from 23 % ( 95 % CI 21.5–24.4 % ) to 16 % ( 95 % CI 14.4–17.9 % ) : RR 0.69 ( 95 % CI 0.61–0.79 ) , P<.001 ; and then to 2.1 % ( 95 % CI 1.8–2.6 % ) : RR 0.13 ( 95 % CI 0.11–0.16 ) , P<.001 . These findings were unchanged after adjusting for potential confounders . CONCLUSION : Extended-spectrum antibiotic prophylaxis involving the addition of azithromycin to st and ard narrow-spectrum prophylaxis was associated with a significant reduction in postcesarean endometritis . LEVEL OF EVIDENCE :
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 .