Cohen Gal, Schreiber Hanoch, Amer Yakin, Shalev-Ram Hila, Eliner Or, Biron-Shental Tal, Kovo Michal
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Gynaecol Obstet. 2025 Jul;170(1):448-455. doi: 10.1002/ijgo.16194. Epub 2025 Feb 1.
To evaluate the effectiveness of a cesarean delivery (CD) bundle including preoperative vaginal preparation, cefazolin and azithromycin administration, compared with cefazolin alone, in reducing postoperative infections, among women undergoing CD during the second stage of labor.
In August 2016, our departmental protocol for preventing infectious morbidity in second-stage CD was revised from preoperative intravenous 2 g cefazolin alone, to preoperative intravenous 2 g cefazolin, intravenous 500 mg azithromycin, and vaginal cleansing with povidone-iodine. In this before-and-after study, the medical records of women who underwent CD during the second stage of labor were reviewed, comparing two time periods: January 2014 to August 2016 (control group, cefazolin alone) and November 2016 to January 2021 (CD bundle group). Obstetric characteristics, postoperative infections, and neonatal outcomes were compared between groups. Composite infectious morbidity was defined as one or more of: endometritis, surgical-site infection (SSI), abscess, urinary tract infection, and postpartum fever.
During the study period, there were 5265 intrapartum CD, among them 457 were during the second stage of labor. The CD bundle group (n = 331) had lower rates of endometritis, SSI, and composite infectious morbidity compared with the control group (n = 126, 1.2% vs. 4.8%, P = 0.030; 3.0% vs. 7.1%, P = 0.049, 6.9% vs. 14.3%, P = 0.014, respectively). Neonatal outcomes did not differ between groups. Multivariable regression analysis adjusted for confounders revealed that the CD bundle reduced the risk for the composite infectious outcome, with adjusted odds ratio 0.08 (95% confidence interval 0.01-0.50).
In second-stage CD, adding preoperative azithromycin and vaginal cleansing to cefazolin was efficacious in reducing postoperative infections.
评估剖宫产（CD）综合方案（包括术前阴道准备、使用头孢唑林和阿奇霉素）与单独使用头孢唑林相比，对第二产程剖宫产妇女术后感染的预防效果。
2016年8月，我科预防第二产程剖宫产感染的方案从术前仅静脉注射2g头孢唑林，改为术前静脉注射2g头孢唑林、静脉注射500mg阿奇霉素并用聚维酮碘进行阴道清洁。在这项前后对照研究中，回顾了第二产程剖宫产妇女的病历，比较了两个时间段：2014年1月至2016年8月（对照组，仅使用头孢唑林）和2016年11月至2021年1月（CD综合方案组）。比较两组的产科特征、术后感染和新生儿结局。复合感染发病率定义为以下一种或多种情况：子宫内膜炎、手术部位感染（SSI）、脓肿、尿路感染和产后发热。
在研究期间，共有5265例分娩期剖宫产，其中457例发生在第二产程。与对照组（n = 126）相比，CD综合方案组（n = 331）的子宫内膜炎、SSI和复合感染发病率较低（分别为1.2%对4.8%，P = 0.030；3.0%对7.1%，P = 0.049；6.9%对14.3%，P = 0.014）。两组新生儿结局无差异。对混杂因素进行调整的多变量回归分析显示，CD综合方案降低了复合感染结局的风险，调整后的优势比为0.08（95%置信区间0.01 - 0.50）。
在第二产程剖宫产中，在头孢唑林基础上增加术前阿奇霉素和阴道清洁可有效降低术后感染。
