Armstrong Hannah, Whitehurst Jane, Morris R Katie, Hodgetts Morton Victoria, Man Rebecca
Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Applied Research Collaboration, West Midlands, United Kingdom.
PLoS One. 2025 May 9;20(5):e0323267. doi: 10.1371/journal.pone.0323267. eCollection 2025.
Childbirth-related perineal trauma affects the vast majority of women who give birth vaginally and subsequent complications such as wound infection occur frequently. Antibiotic prophylaxis is not currently recommended following first or second degree tears, or episiotomies. We aimed to evaluate the effectiveness of prophylactic antibiotics for preventing complications from perineal trauma across all types of childbirth-related perineal trauma.
Databases were searched from inception to February 2024. Randomised controlled trials, non-randomised interventional studies and observational studies were eligible for inclusion where women experienced childbirth-related perineal trauma and received antibiotic prophylaxis or placebo, including any type of tear or episiotomy. The primary outcome was perineal wound infection. Results were combined into meta-analysis using a random effects model.
14 studies were eligible for inclusion (eight randomised controlled trials, six observational) involving 8,878 women. Ten studies were deemed to have a high overall risk of bias. Overall the GRADE certainty of findings were low. Twelve studies were included in the analysis for perineal wound infection, involving 8,438 women. There was a reduced rate of perineal wound infection when prophylactic antibiotics were received (relative risk 0.57, 95% confidence interval 0.48 to 0.67). The subgroup analysis by type of tear demonstrated association with reduced risk of infection when prophylactic antibiotics were received, in the non-obstetric anal sphincter injuries combined subgroup (relative risk 0.50, 95% confidence interval 0.41-0.63) and the episiotomy only subgroup (relative risk 0.57, 95% confidence interval 0.36-0.91).
Prophylactic antibiotics are associated with a reduced risk of perineal wound infection. Despite these findings, there are not sufficient high-quality randomised controlled trials to adequately inform guideline change amongst women with first/second degree tears or episiotomies. We recommend that an adequately powered, robust, randomised controlled trial is needed amongst women with first/second degree tears or episiotomies after spontaneous birth.
与分娩相关的会阴创伤影响绝大多数经阴道分娩的女性，并且诸如伤口感染等后续并发症经常发生。目前对于一度或二度撕裂伤或会阴切开术后不建议使用抗生素进行预防。我们旨在评估预防性使用抗生素对预防各类与分娩相关的会阴创伤并发症的有效性。
检索自数据库建立至2024年2月的文献。纳入随机对照试验、非随机干预性研究和观察性研究，研究对象为经历与分娩相关会阴创伤并接受抗生素预防或安慰剂的女性，包括任何类型的撕裂伤或会阴切开术。主要结局是会阴伤口感染。采用随机效应模型将结果合并进行荟萃分析。
14项研究符合纳入标准（8项随机对照试验，6项观察性研究），涉及8878名女性。10项研究被认为总体偏倚风险较高。总体而言，研究结果的GRADE确定性较低。12项研究纳入会阴伤口感染分析，涉及8438名女性。接受预防性抗生素治疗时，会阴伤口感染率降低（相对风险0.57，95%置信区间0.48至0.67）。按撕裂伤类型进行的亚组分析表明，在非产科肛门括约肌损伤合并亚组（相对风险0.50，95%置信区间0.41 - 0.63）和仅会阴切开术亚组（相对风险0.57，95%置信区间0.36 - 0.91）中，接受预防性抗生素治疗与感染风险降低相关。
预防性使用抗生素与降低会阴伤口感染风险相关。尽管有这些发现，但尚无足够的高质量随机对照试验来充分为一度/二度撕裂伤或会阴切开术女性的指南变更提供依据。我们建议对自然分娩后有一度/二度撕裂伤或会阴切开术的女性进行一项有足够效力、稳健的随机对照试验。
