Surgical Site Infection After Episiotomy Repair Related to Routine Use of Antibiotic Prophylaxis in Low-Risk Population
Condition: Surgical Site Infection
MeSH terms: Infections; Communicable Diseases; Surgical Wound Infection
Study type: Observational

Summary: 
      Bacterial infections occurring during labor, childbirth, and the puerperium may be associated
      with considerable maternal and perinatal morbidity and mortality. Antibiotic prophylaxis
      might reduce wound infection incidence after an episiotomy, particularly in situations
      associated with a higher risk of postpartum perineal infection, such as midline episiotomy,
      extension of the incision, or in settings where the baseline risk of infection after vaginal
      birth is high. However, available evidence is unclear concerning the role of prophylactic
      antibiotics in preventing infections after an episiotomy.
    

Detailed description: 
      Maternal mortality is unacceptably high worldwide, with an estimated 300,000 women dying in
      2017, of which around 200,000 deaths were in sub-Saharan Africa. Maternal infection, leading
      to sepsis, is a leading contributor to these deaths. Yet data for the incidence and cause of
      maternal infection are scarce.

      Several pre-existing maternal conditions may increase the risk of developing bacterial
      infections among women expected to have uncomplicated vaginal births. These include
      conditions such as malnutrition, anemia, bacterial vaginosis, and group B streptococcus
      infections. In addition, complications during labor and childbirth (e.g. prolonged rupture of
      membranes, prolonged labor, lacerations of the genital tract and retained products of
      conception) or provider interventions (e.g. frequent vaginal examinations, operative vaginal
      birth (forceps, vacuum), and episiotomy) might increase the risk of infection in the
      puerperium.

      Episiotomy is an intended incision taken on the perineum during the second stage of labor
      considered for indications in which failure to perform it will result in significant perineal
      rupture.

      Spontaneous vaginal delivery (SVD) is one which occurs when a pregnant woman goes into labor
      without the use of drugs or other techniques to induce labor and she delivers her baby
      through the vagina (birth canal) without forceps, vacuum extraction, or a cesarean section.
      Out of the about four million deliveries occurring in the United States each year, most of
      them are spontaneous vaginal deliveries.

      Socioeconomic status (SES) is one of the most important factors associated with medical
      outcomes. When SES is low, medical care is inadequate and this has been attributed to adverse
      outcomes. In pregnant women, low SES can increase the risk of adverse pregnancy outcomes.

      Antibiotic prophylaxis is recommended to avoid infectious complications of infection-prone
      obstetrical procedures, such as caesarean section, manual removal of the placenta, and repair
      of third- or fourth-degree perineal tears. Episiotomies are anatomically similar to a
      second-degree perineal laceration, involving the vaginal mucosa, connective tissue, and
      underlying muscles, and might not warrant the routine use of prophylactic antibiotics.
      However, the use of prophylactic antibiotics for episiotomies seems to vary widely. While in
      high-income countries there is, to our knowledge, no report on the use of prophylactic
      antibiotics for episiotomies, and clinical recommendations do not mention their use in the
      absence of infection, it seems to be very common practice in some low-income countries, where
      the majority of women have episiotomies and receive prophylactic antibiotics.
    

Intervention name(s): Antibiotics
Intervention type(s): Drug
Intervention description(s): After the woman had a repaired episiotomy following uncomplicated vaginal birth at 37 weeks or greater with no indication for ongoing antibiotics in the postpartum period. The patients were randomized to receive a co-amoxiclav 625mg (study group) tabs twice daily for 3 days after delivery or no antibiotic arm (control group).
Other intervention name(s): Augmentin 625 mg; Co-amoxicalv 625 mg
Intervention MeSH terms: Anti-Bacterial Agents; Amoxicillin-Potassium Clavulanate Combination
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The target populations of this study were all patients who underwent episiotomy repair
        following uncomplicated vaginal birth at 37 weeks or greater with no indication for ongoing
        antibiotics in the postpartum period.
      
Keywords: Episiotomy Repair