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Infection – A Complication of C-Section
The most important risk factor to acquiring infection in mothers who deliver babies is having a Cesarean section or C-section, according to researchers. Since many of these abdominal deliveries are done under emergency conditions, the risk for infection after the operation increases. Although infection is a common complication of surgery its effect on the mother is further aggravated by other factors like surgical blood loss, decreased resistance and concomitant conditions like diabetes and heart disease.
Postoperative wound infections are usually brought about by microorganisms normally found on the skin or other tissues but are translocated to a sterile site, or an organ or tissue, such as the uterus, that does not usually harbor the organism. To address this, obstetricians and surgeons generally recommend giving patients prophylactic or preventive antibiotics before the operation to reduce the risk for postoperative wound infection. However, there have been many cases where antibiotic resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Candida have caused wound infections and serious complications.
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Antibiotic Prophylaxis in C-Section
The benefits of giving prophylactic antibiotic in C-section have been cited in reviews of different studies involving thousands of women who underwent abdominal delivery. The results of the reviews showed significant decrease (more than 30 percent) in the incidences of serious complications like wound infection, inflammation of the uterine lining (endometritis) and fever.
In general, the current guidelines for antibiotic prophylaxis for most surgeries including C-section recommend administration of narrow-spectrum antibiotics like cephalosporins (such as cefazolin) which are appropriate first line agents targeting most microorganisms most likely to cause infection. Broad-spectrum antibiotics must be avoided to prevent development of antimicrobial resistance. Furthermore, prophylaxis should be done in less than 24 hours for the same purpose. In patients with known allergy to cefazolin, clindamycin or vancomycin may be given instead.
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Current Issues on Prophylactic Antibiotics for C-Section
Current guidelines recommend that antibiotics should be given right after the clamping of the umbilical cord to prevent these medications from entering the fetal blood circulation. This aims to protect the baby from developing resistant infections including oral thrush. However, some doctors prefer to give the antibiotics pre-operatively, right before skin incision on the abdomen. Still others allow antibiotic administration within one hour prior to surgery. This is the usual procedure done for other surgeries which do not involve a fetus-in-utero. There is not much evidence for or against these views on the effect on the baby but the benefits to the mother are positive in any case.
Another issue is the use of broad spectrum antibiotics, which according to some reviews also decrease the risk of postoperative wound infection in c-sections almost by 50 percent. Although the theoretical advantage of using narrow-spectrum antibiotics is safer no studies have been done to compare the two treatments.
Some obstetricians do not believe in the use of prophylactic antibiotics for all cases of cesarean sections. Other ways to decrease the risk for postoperative infections are to maintain sterility in the operating area, to apply sterile techniques, to shorten operative time and to allow spontaneous removal of the placenta rather than manual extraction.
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Physorg, “Routine Antibiotic Use Reduces Mothers’ Infection Risk From C-Section”, http://www.physorg.com/news183387263.html
American College of Obstetricians and Gynecologists, "Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery: A Systematic Review”, http://journals.lww.com/greenjournal/Abstract/2009/03000/Emerging_Concepts_in_Antibiotic_Prophylaxis_for.17.aspx