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Antimicrobial prophylaxis for Cesarean delivery: before or after cord clamping?

Swiss Association of Obstetric Anesthesia (SAOA) Fall meeting / SSAR 2011 Interlaken, October 27 th , 2011. Antimicrobial prophylaxis for Cesarean delivery: before or after cord clamping?. Dr Emmanuel Boselli Anesthesiology and Intensive Care Department Édouard Herriot Hospital, HCL

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Antimicrobial prophylaxis for Cesarean delivery: before or after cord clamping?

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  1. Swiss Association of Obstetric Anesthesia (SAOA) Fall meeting / SSAR 2011 Interlaken, October 27th, 2011 Antimicrobial prophylaxis for Cesarean delivery: before or after cord clamping? Dr Emmanuel Boselli Anesthesiology and Intensive Care Department Édouard Herriot Hospital, HCL Lyon, France emmanuel.boselli@chu-lyon.fr

  2. Cesaeran section Risk factor for : • post-partum infection • maternal morbidity •  length of stay Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  3. Post-partum infection No antimicrobial prophylaxis Polymicrobial : • Gram + cocci • Gram - bacilli • Anaerobes Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  4. Prevention of infection Rigorous surgical technique Skin disinfection Antimicrobial prophylaxis Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  5. Antimicrobial prophylaxis  infectious complications • endometritis • wound infection • bacteremia or severe infection  length of stay Smaill F et al. Cochrane Database Syst Rev 2002;CD000933 Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  6. Antimicrobial agent Single-dose cefazolin (1GC) • as efficient as larger-spectrum agents • as efficient as multiple-doses Allergy : clindamycin Hopkins L et al. Cochrane Database Syst Rev 2000;CD001136 Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  7. Optimal timing? Surgery = before skin incision Cesarean = after cord clamping • modification of neonatal flora? • risk of neonatal necrotic enterocolitis? Recent data : better before? Thigpen BD et al. Am J Obstet Gynecol 2005;192:1864–71 Sullivan SA et al. Am J Obstet Gynecol 2007;196:455[e1–e5] Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  8. Methods 3 electronic databases • Pubmed • Cochrane • Embase Period: 1966-2008 Keywords: • antibiotics, antimicrobial • cesarean • prophylactic, prophylaxis Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  9. Flow chart 201 potential trials 10 exclusions (Non RCTs) 191 RCTs concerning prophylaxis 25 exclusions (Non IV prophylaxis) 166 RCTs concerning IV prophylaxis 161 exclusions (Efficacy studies) 5 RCTs comparing timing (n = 1108) Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  10. Results Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  11. Maternal outcome

  12. Neonatal outcome

  13. Results before vs after cord clamping Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  14. Conclusion Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  15. Antimicrobial prophylaxisbefore cord clamping  endometritis  maternal infectious morbidity No effect on neonatal outcome • Not primary outcome • β-lactams widely used during pregnancy Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

  16. Antimicrobial prophylaxis for Cesarean section before cord clamping:To be recommended? Fall meeting / SSAR 2011, Interlaken, October 27th, 2011

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