Timing of prophylactic antibiotic administration in term cesarean section: a randomized clinical trial

ABSTRACT

Antibiotic prophylaxis would benefit all cesarean section patients and may decrease morbidity and length of hospital stay. The present study was conducted to determine whether the administration of cefazolin prior to skin incision was superior to administration at the time of umbilical cord clamping for prevention of post-cesarean maternal-neonatal infections morbidity. This was a randomized, double-blinded clinical trial. During the study period, 287 cesarean sections for singleton term pregnancies with intact membranes or passed less than 18 hours from rupture of membrane were entered. A total of 196 patients received 2gr cefazolin before incision and 91 patients received 2gr cefazolin after cord clamping. The occurrence of surgical site opening, total infectious morbidity and neonatal complications were compared between these groups. Two groups were demographically identical. Rate of IV line need [RR=1.87, 95%CI0.21-17.02], neonatal sepsis [RR=1.39, 95% Cl0.14-13.64] and NICU admission [RR=0.19, 95%Cl 0.21-17.02] were not significantly differed between groups. We suggest the standard cefazolin prophylaxis [after cord clamping] for elective cesarean section and cefazolin before incision for non elective cesarean section. Therefore, administration of prophylactic cefazolin prior to incision will not increase the rate of neonatal sepsis