Giouleka Sonia, Tsakiridis Ioannis, Chalkia-Prapa Eleni-Markella, Katzi Florentia, Liberis Anastasios, Michos Georgios, Kalogiannidis Ioannis, Mamopoulos Apostolos, Dagklis Themistoklis
Resident, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Assistant Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Obstet Gynecol Surv. 2025 Mar;80(3):186-203. doi: 10.1097/OGX.0000000000001371.
The administration of prophylactic antibiotics in obstetrics and gynecology represents a pivotal intervention with a major contribution to the prevention of maternal and neonatal infectious morbidity.
The aim of this study was to review and compare the most recently published guidelines on prophylactic antibiotic use in obstetric and gynecologic procedures.
A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on antibiotic prophylaxis was carried out.
There is a consensus among the reviewed guidelines regarding the importance of antibiotic prophylaxis prior to cesarean delivery, hysterectomy, colporrhaphy and surgical-induced abortions, the optimal choice of antibiotics, and the timing of administration, as well as the indications for increased and additional doses. First-generation cephalosporins are unanimously recommended as first-line antibiotics. All the reviewed guidelines recommend antibiotic prophylaxis in case of preterm prelabor rupture of membranes, whereas they discourage routine antibiotic use in case of active preterm labor with intact membranes or cervical cerclage placement. There is also an overall agreement that antibiotic prophylaxis should not be given for hysteroscopic and laparoscopic procedures with no entry into the bowel or the vagina, endometrial biopsy, intrauterine device insertion, or cervical tissue excision surgeries. Moreover, all the guidelines agree that women undergoing hysterosalpingography should receive a course of antibiotics only when the fallopian tubes are abnormal or there is a history of pelvic inflammatory disease. In contrast, inconsistency was identified on the need of antibiotic prophylaxis in case of obstetric anal sphincter injuries, operative vaginal delivery, and early pregnancy loss. Finally, American College of Obstetricians and Gynecologists states that antibiotics should not be routinely offered for oocyte retrieval and embryo transfer.
Infectious complications following both obstetric and gynecological procedures are significant contributors of morbidity and mortality, rendering their prevention using antibiotic prophylaxis a crucial aspect of preoperative care. Nevertheless, antibiotic overuse should be avoided. Thus, it seems of paramount importance to develop consistent international practice protocols for the appropriate use of antibiotics in everyday practice to minimize their adverse effects and maximize their associated benefits.
妇产科预防性抗生素的使用是一项关键干预措施，对预防孕产妇和新生儿感染性发病具有重大贡献。
本研究旨在回顾和比较最近发表的关于妇产科手术中预防性使用抗生素的指南。
对美国妇产科医师学会、加拿大妇产科医师协会以及澳大利亚和新西兰皇家妇产科医师学院关于抗生素预防的指南进行了描述性回顾。
在所审查的指南中，对于剖宫产、子宫切除术、阴道修补术和手术诱导流产前抗生素预防的重要性、抗生素的最佳选择、给药时间以及增加和额外剂量的指征存在共识。第一代头孢菌素被一致推荐为一线抗生素。所有审查的指南都建议在胎膜早破早产时进行抗生素预防，而对于胎膜完整的活跃早产或宫颈环扎术则不鼓励常规使用抗生素。此外，总体上一致认为，对于未进入肠道或阴道的宫腔镜和腹腔镜手术、子宫内膜活检、宫内节育器插入或宫颈组织切除手术，不应给予抗生素预防。而且，所有指南都同意，只有在输卵管异常或有盆腔炎病史时，接受子宫输卵管造影的女性才应接受一个疗程的抗生素治疗。相比之下，对于产科肛门括约肌损伤、手术助产和早期流产时是否需要抗生素预防存在不一致意见。最后，美国妇产科医师学会指出，不应常规为取卵和胚胎移植提供抗生素。
妇产科手术后的感染并发症是发病和死亡的重要原因，使用抗生素预防感染是术前护理的关键环节。然而，应避免抗生素的过度使用。因此，制定一致的国际实践方案以在日常实践中合理使用抗生素，以尽量减少其不良反应并最大化其相关益处似乎至关重要。
