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AbstractBACKGROUND:The single most
Abstract
BACKGROUND:
The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms.
OBJECTIVES:
To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section.
SEARCH STRATEGY:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).
SELECTION CRITERIA:
Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section.
DATA COLLECTION AND ANALYSIS:
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
MAIN RESULTS:
We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been adequately addressed.
AUTHORS' CONCLUSIONS:
Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.
BACKGROUND:
The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms.
OBJECTIVES:
To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section.
SEARCH STRATEGY:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).
SELECTION CRITERIA:
Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section.
DATA COLLECTION AND ANALYSIS:
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
MAIN RESULTS:
We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been adequately addressed.
AUTHORS' CONCLUSIONS:
Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.
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AbstractBACKGROUND:The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms.OBJECTIVES:To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section.SEARCH STRATEGY:We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).SELECTION CRITERIA:Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section.DATA COLLECTION AND ANALYSIS:Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.MAIN RESULTS:We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been adequately addressed.AUTHORS' CONCLUSIONS:
Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.
Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.
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Abstrak
LATAR BELAKANG:
Faktor risiko yang paling penting untuk infeksi ibu postpartum adalah operasi caesar. Profilaksis rutin dengan antibiotik dapat mengurangi risiko ini dan harus dinilai dari segi manfaat dan bahaya.
TUJUAN:
Untuk menilai efek dari antibiotik profilaksis dibandingkan dengan tidak ada antibiotik profilaksis pada komplikasi infeksi pada wanita yang menjalani operasi caesar.
PENCARIAN STRATEGI:
Kami mencari Kehamilan Cochrane dan Trials Melahirkan Group Register (Mei 2009).
SELEKSI KRITERIA:
acak terkontrol (RCT) dan quasi-RCT membandingkan efek dari antibiotik profilaksis versus tanpa pengobatan pada wanita yang menjalani operasi caesar.
PENDATAAN dAN ANALISIS:
Dua penulis independen dinilai studi untuk inklusi, risiko yang dinilai bias dan dilakukan ekstraksi data.
HASIL UTAMA:
Kami mengidentifikasi 86 studi yang melibatkan lebih dari 13.000 wanita. Antibiotik profilaksis pada wanita yang menjalani operasi caesar secara substansial mengurangi kejadian morbiditas demam (rasio risiko rata-rata (RR) 0,45; 95% confidence interval (CI) 0,39-0,51, 50 studi, 8141 perempuan), infeksi luka (rata RR 0,39; 95% CI 0,32-0,48, 77 studi, 11.961 perempuan), endometritis (RR 0,38; 95% CI 0,34-0,42, 79 studi, 12.142 perempuan) dan komplikasi infeksi serius ibu (RR 0,31; 95% CI 0,19-0,48, 31 studi, 5047 perempuan). Tidak ada kesimpulan yang bisa dibuat tentang efek samping ibu lainnya dari studi ini (RR 2,43; 95% CI 1,00-5,90, 13 studi, 2.131 perempuan). Tak satu pun dari 86 studi melaporkan hasil yang merugikan bayi dan khususnya tidak ada penilaian dari oral thrush bayi. Tidak ada pengumpulan data yang sistematis pada resistensi obat bakteri. Temuan serupa apakah operasi caesar adalah elektif atau non elektif, dan apakah antibiotik itu diberikan sebelum atau setelah tali pusat penjepit. Secara keseluruhan, kualitas metodologi percobaan tidak jelas dan hanya dalam beberapa studi adalah jelas bahwa potensi sumber bias telah ditangani secara memadai.
KESIMPULAN PENULIS ':
Endometritis berkurang oleh dua pertiga sampai tiga perempat dan penurunan infeksi luka adalah juga diidentifikasi. Namun, ada informasi yang tidak lengkap dikumpulkan tentang efek samping potensial, termasuk efek antibiotik pada bayi, membuat penilaian manfaat secara keseluruhan dan merugikan rumit. Antibiotik profilaksis yang diberikan kepada semua wanita yang menjalani operasi caesar elektif atau non-elektif jelas menguntungkan bagi wanita tapi ada ketidakpastian tentang konsekuensi untuk bayi.
LATAR BELAKANG:
Faktor risiko yang paling penting untuk infeksi ibu postpartum adalah operasi caesar. Profilaksis rutin dengan antibiotik dapat mengurangi risiko ini dan harus dinilai dari segi manfaat dan bahaya.
TUJUAN:
Untuk menilai efek dari antibiotik profilaksis dibandingkan dengan tidak ada antibiotik profilaksis pada komplikasi infeksi pada wanita yang menjalani operasi caesar.
PENCARIAN STRATEGI:
Kami mencari Kehamilan Cochrane dan Trials Melahirkan Group Register (Mei 2009).
SELEKSI KRITERIA:
acak terkontrol (RCT) dan quasi-RCT membandingkan efek dari antibiotik profilaksis versus tanpa pengobatan pada wanita yang menjalani operasi caesar.
PENDATAAN dAN ANALISIS:
Dua penulis independen dinilai studi untuk inklusi, risiko yang dinilai bias dan dilakukan ekstraksi data.
HASIL UTAMA:
Kami mengidentifikasi 86 studi yang melibatkan lebih dari 13.000 wanita. Antibiotik profilaksis pada wanita yang menjalani operasi caesar secara substansial mengurangi kejadian morbiditas demam (rasio risiko rata-rata (RR) 0,45; 95% confidence interval (CI) 0,39-0,51, 50 studi, 8141 perempuan), infeksi luka (rata RR 0,39; 95% CI 0,32-0,48, 77 studi, 11.961 perempuan), endometritis (RR 0,38; 95% CI 0,34-0,42, 79 studi, 12.142 perempuan) dan komplikasi infeksi serius ibu (RR 0,31; 95% CI 0,19-0,48, 31 studi, 5047 perempuan). Tidak ada kesimpulan yang bisa dibuat tentang efek samping ibu lainnya dari studi ini (RR 2,43; 95% CI 1,00-5,90, 13 studi, 2.131 perempuan). Tak satu pun dari 86 studi melaporkan hasil yang merugikan bayi dan khususnya tidak ada penilaian dari oral thrush bayi. Tidak ada pengumpulan data yang sistematis pada resistensi obat bakteri. Temuan serupa apakah operasi caesar adalah elektif atau non elektif, dan apakah antibiotik itu diberikan sebelum atau setelah tali pusat penjepit. Secara keseluruhan, kualitas metodologi percobaan tidak jelas dan hanya dalam beberapa studi adalah jelas bahwa potensi sumber bias telah ditangani secara memadai.
KESIMPULAN PENULIS ':
Endometritis berkurang oleh dua pertiga sampai tiga perempat dan penurunan infeksi luka adalah juga diidentifikasi. Namun, ada informasi yang tidak lengkap dikumpulkan tentang efek samping potensial, termasuk efek antibiotik pada bayi, membuat penilaian manfaat secara keseluruhan dan merugikan rumit. Antibiotik profilaksis yang diberikan kepada semua wanita yang menjalani operasi caesar elektif atau non-elektif jelas menguntungkan bagi wanita tapi ada ketidakpastian tentang konsekuensi untuk bayi.
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