[ effect of intravenous cefazolin on infectious complications following low- risk cesarean]

Cesarean section is one of the most common surgeries in modern obstetrics. Infectious complications such as fever, wound infection, endometritis and urinary tract infection are the most serious complications following cesarean. Nevertheless, there are no uniform recommendations regarding the application of prophylactic antibiotics. Since inappropriate application of antibiotics could impose high costs as well as drug side effects and emergence of resistant microorganisms, this study was carried out with the aim of evaluating the effect of prophylactic antibiotics on infectious complications following the low-risk cesarean section. This prospective, clinical trial study was performed on 257 patients who underwent low-risk cesarean section. The patients were randomly divided into treatment [A] and control [B] groups. The patients in group A received 2gr intravenous cefazolin at cord clamping, while the control group received no antibiotic. The patients were evaluated during the first 48 hours, the first week, the second week, and the sixth week following the surgery and infectious complications were compared in two groups. Out of 257 patients, 16 cases [6.2%] developed infectious complications of whom 6 patients [4.7%] were in group A and 10 patients [7.8%] fell into group B. Complications included fever [2.3% in each group], endometritis [0.8% in group A and 2.3% in group B], urinary infection [1.6% in group A and 3.1% in group B], wound infection [1.6% in group A and 2.3% in group B] and wound dehiscence [1.6% in each group]. No significant difference was observed between the administration of prophylactic antibiotic and the complications. Moreover, the duration of hospital stay following cesarean section was not statistically different in each group. Based on the study findings it can be recommended that prophylactic antibiotic be restricted only to the high-risk cesarean section individuals

[Risk factors associated with forth-degree laceration during vaginal delivery]

To identify the risk factors of fourth-degree laceration during vaginal delivery. This is a retrospective, case control study. We reviewed 131802 records of vaginal deliveries within 14 years period from 1990 to 2004 in two obstetric center. Cases were 93 vaginal deliveries with fourth-degree laceration and 7 cases were delivered at home, control subjects were 200 vaginal deliveries without third- or fourth-degree lacerations and were identified with the use of random selection. We studied the effects of: maternal age, nationality, parity, gestational age, hour of delivery, birth attendants, episiotomy use and duration of second stage of labor, use of oxytocin, use of forceps or vaccum, Infant birth weight, presentation and postion of fetus, previous severe perineal injury, maternal medical illness and place of delivery. We found 93 cases [%0.07] of documented fourth-degree laceration in 131802 deliveries This study identified several factors associated with fourth-degree laceration. Median episiotomy should be avoided. Nulliparity, fetal macrosomia and OP position are significant risk factors that require caution by birth attendants during delivery