Dept of Obstetrics and Gynecology, JIPMER, No 11, Type DII Quarters, JIPMER Campus, Dhanvantari Nagar, Puducherry, 605006, India.
Arch Gynecol Obstet. 2013 Dec;288(6):1263-8. doi: 10.1007/s00404-013-2906-9. Epub 2013 May 29.
To compare the efficacy of ceftriaxone before skin incision and after cord clamping in preventing post-operative infectious morbidity and neonatal outcome in elective caesarean section and to determine the effect of antibiotic prophylaxis before skin incision on neonatal outcome.
Our study was a randomised controlled trial conducted among 874 women undergoing elective caesarean section from October 2010 to July 2012. These women were randomly categorised into two groups with 437 women in each group. Group 1 received single dose of ceftriaxone 1 g intravenously 15-45 min before skin incision. Group 2 received the antibiotic after cord clamping. Primary outcome measures were maternal post-operative infectious morbidities like surgical site wound infection, febrile morbidity, endometritis, urinary tract infections and neonatal sepsis. Results were analysed using Chi-square test and unpaired t test.
Surgical site wound infection occurred in 3 women in group 1 (0.7%) and 6 women in group 2 (1.4%). Fever occurred in 9 women in group 1 (2.1%) and 5 in group 2 (1.1%) with the p value of 0.419, not statistically significant. Urinary tract infection occurred in 9 women in group 1 (2.1%) and 7 women in group 2 (1.6%) with the p value of 0.801. None of the women in either group developed endometritis. About 20 neonates [10 neonates (2.3%) in group 1 and 10 neonates (2.3%) in group 2] required NICU admission after caesarean delivery. The reasons for admission were respiratory distress, prematurity and congenital anomaly. About 0.9% of neonates in group 1 and 1.8% in group 2 developed neonatal sepsis with positive blood culture (p = 0.388).
Timing of administration of prophylactic antibiotics for elective caesarean section either before skin incision or after cord clamping did not have significant difference in the occurrence of post-operative infectious morbidity. No adverse neonatal outcome was observed in women who received the antibiotic before skin incision.
比较剖宫产术切皮前和断脐后使用头孢曲松预防术后感染发病率和新生儿结局的疗效，并确定切皮前使用抗生素预防对新生儿结局的影响。
我们的研究是 2010 年 10 月至 2012 年 7 月间进行的一项随机对照试验，共纳入 874 例行择期剖宫产的妇女。这些妇女被随机分为两组，每组 437 人。组 1 产妇切皮前 15-45 分钟静脉注射头孢曲松 1 g 单次剂量。组 2 产妇在断脐后给予抗生素。主要观察指标为产妇术后感染发病率，如手术部位伤口感染、发热发病率、子宫内膜炎、尿路感染和新生儿败血症。结果采用卡方检验和独立样本 t 检验进行分析。
组 1 有 3 名（0.7%）产妇发生手术部位伤口感染，组 2 有 6 名（1.4%）产妇发生手术部位伤口感染，两组比较差异无统计学意义（p = 0.419）。组 1 有 9 名（2.1%）产妇发热，组 2 有 5 名（1.1%）产妇发热，两组比较差异无统计学意义（p = 0.801）。两组均无产妇发生子宫内膜炎。两组各有 20 名（10 名/组）新生儿在剖宫产术后需要入住新生儿重症监护病房（NICU）。入住 NICU 的原因是呼吸窘迫、早产和先天性异常。组 1 有 10 名（2.3%）新生儿和组 2 有 10 名（2.3%）新生儿血培养阳性，发生新生儿败血症，两组比较差异无统计学意义（p = 0.388）。
择期剖宫产术切皮前或断脐后预防性使用抗生素，在术后感染发病率方面无显著差异。切皮前使用抗生素的产妇未观察到新生儿不良结局。
