fections or harmful effects in the

fections or harmful effects in the infant, either approach can be
recommended.
A U T H O R S ’ C O N C L U S I O N S
Implications for practice
Prophylactic antibiotics will reduce the incidence of endometritis
following both elective and non-elective cesarean section by
two thirds to three quarters and the incidence of wound infection
by up to three quarters. Post-partum febrile morbidity and
the incidence of urinary tract infections are also decreased. Fewer
serious complications will occur. All units should have a policy
that recommends the administration of prophylactic antibiotics
for women undergoing cesarean section. Obstetrical units should
collect information on infection rates following cesarean section
as an important quality indicator.
Implications for research
Further placebo controlled trials of the effectiveness of antibiotics
with cesarean section are not ethically justified. Research should
concentrate onmethods to implement effective policies of routine
prophylaxis for women undergoing cesarean section. Rates of infection
following cesarean section are higher than for many other
surgical procedures, even with a policy of uniform prophylaxis.
Future research should look at interventions to reduce further the
incidence of infection from that achieved with our current approach
to antibiotic prophylaxis, eg the topical vaginal administration
of metronidazole (Pitt 2001) and determine the role of surgical
technique, pre- and intra-operative preparation and infection
control policies on infection rates.
There is the potential opportunity for a cost-effective analysis to be
performed in a unit where routine prophylactic antibiotics are not
administered to women undergoing an elective cesarean section
and where the risk of infection is very low, in an attempt to identify
women at increased risk of infection in whom prophylaxis may be
cost-effective. However, there is currently no evidence to support
such a strategy. Because of local variation in practice and patients,
the results of such research will likely only be applicable to an
individual unit and not generalizable.
Better data on the safety of the intervention for themother and infant
are needed. Studies should be undertaken to determine what
role antimicrobial prophylactic regimens have in the development
of antimicrobial resistance. Research into the perceptions of the
advantages and disadvantages of the intervention from the perspective
of the woman and the healthcare provider will help define
educational and research needs.
There is a need for more information about the role of bacterial
vaginosis and infectious complications following cesarean section
and whether this has implications for current prophylactic recommendations.
F E E D B A C K
Griffin, July 1999
Summary
It has been stated that manual removal of the placenta during caesarean
section increases the risk of endometritis, when compared
to cord traction for placental delivery. Occlusive dressings also increase
wound healing and decrease the risk of wound infection.
Would it be better to adopt these simple measures first and then
trial antibiotic therapy again?
Summary of comments from Chris Griffin, July 1999.
Author’s reply
Infection following caesarean sectionmay be reduced by the use of
cord traction to remove the placenta and occlusive wound dressings.
Most trials of prophylactic antibiotic therapy do not specify
the methods of placental removal and wound care, and may represent
a mixture of various methods. Given the clinically important
reduction of infection with antibiotic use in general, support
for a policy of not using antibiotics would require evidence from
randomized trials that in the context of placental removal by cord
traction and occlusive wound dressings, antibiotic therapy confers
no additional benefit.
Contributors
Summary of response fromFiona Smaill and Justus Hofmeyr,October
1999.
P O T E N T I A L C O N F L I C T O F
I N T E R E S T
None known.
A C K N OWL E D G E M E N T S
None.
S O U R C E S O F S U P P O R T
External sources of support
• UNDP/UNFPA/WHO/World Bank (HRP) SWITZERLAND
Internal sources of support
• University of the Witwatersrand SOUTH AFRICA

Results (Indonesian) 1:

fections atau efek berbahaya pada bayi, pendekatan baik dapatdirekomendasikan.U T H O R S ' C O N C L U S SAYA O N SImplikasi untuk latihanAntibiotik profilaksis akan mengurangi endometritismengikuti elektif dan bebas-mata Caesar olehdua pertiga tiga perempat dan kejadian infeksi lukaoleh hingga tiga perempat. Post-partum demam morbiditas danKejadian infeksi saluran kemih juga menurun. Lebih sedikitkomplikasi serius akan terjadi. Semua unit harus memiliki kebijakanyang merekomendasikan administrasi profilaksis antibiotikuntuk wanita yang menjalani Caesar. Obstetri unit harusmengumpulkan informasi mengenai tingkat infeksi yang mengikuti Caesarsebagai indikator kualitas penting.Implikasi untuk penelitianLebih lanjut plasebo terkendali uji efektivitas antibiotikdengan Caesar tidak etis dibenarkan. Penelitian harusberkonsentrasi onmethods untuk menerapkan kebijakan-kebijakan yang efektif rutinprofilaksis untuk wanita yang menjalani Caesar. Tingkat infeksisetelah Caesar lebih untuk banyak lainnyaprosedur bedah, bahkan dengan kebijakan profilaksis seragam.Masa depan penelitian harus melihat intervensi untuk mengurangi lebih lanjutKejadian infeksi dari yang dicapai dengan pendekatan saat iniuntuk profilaksis antibiotik, misalnya pemerintahan vagina topikalmetronidasol (Pitt 2001) dan menentukan peran bedahteknik, persiapan pra- dan intra-operasi, dan infeksikontrol Kebijakan pada tingkat infeksi.Ada potensi kesempatan untuk analisis biaya-efektif untuk menjadidilakukan dalam unit mana rutin profilaksis antibiotik yang tidakdiberikan kepada wanita yang menjalani Caesar elektifdan di mana risiko infeksi sangat rendah, dalam upaya untuk mengidentifikasiperempuan pada peningkatan risiko infeksi yang profilaksis mungkinhemat biaya. Namun, saat ini tidak terdapat bukti untuk mendukungsebuah strategi. Karena variasi lokal dalam praktek dan pasien,hasil dari penelitian tersebut mungkin hanya akan berlaku untukmasing-masing unit dan tidak digeneralisasikan.Data yang lebih baik pada keselamatan intervensi untuk pelayanan kesehatan ibu dan bayidiperlukan. Penelitian harus dilakukan untuk menentukan apamemiliki peran antimikroba rejimen profilaksis dalam pengembanganresistensi antimikroba. Penelitian persepsikeuntungan dan kerugian dari intervensi dari perspektifwanita dan penyedia layanan kesehatan akan membantu menentukanpendidikan dan penelitian.Ada kebutuhan untuk informasi lebih lanjut tentang peran bakterivaginosis dan komplikasi infeksi yang mengikuti Caesardan apakah ini memiliki implikasi untuk rekomendasi profilaksis.F E E D B C KGriffin, Juli 1999RingkasanTelah menyatakan bahwa penghapusan manual tanda plasenta selama melahirkanBagian meningkatkan risiko endometritis, bila dibandingkanto cord traction for placental delivery. Occlusive dressings also increasewound healing and decrease the risk of wound infection.Would it be better to adopt these simple measures first and thentrial antibiotic therapy again?Summary of comments from Chris Griffin, July 1999.Author’s replyInfection following caesarean sectionmay be reduced by the use ofcord traction to remove the placenta and occlusive wound dressings.Most trials of prophylactic antibiotic therapy do not specifythe methods of placental removal and wound care, and may representa mixture of various methods. Given the clinically importantreduction of infection with antibiotic use in general, supportfor a policy of not using antibiotics would require evidence fromrandomized trials that in the context of placental removal by cordtraction and occlusive wound dressings, antibiotic therapy confersno additional benefit.ContributorsSummary of response fromFiona Smaill and Justus Hofmeyr,October1999.P O T E N T I A L C O N F L I C T O FI N T E R E S TNone known.A C K N OWL E D G E M E N T SNone.S O U R C E S O F S U P P O R TExternal sources of support• UNDP/UNFPA/WHO/World Bank (HRP) SWITZERLANDInternal sources of support• University of the Witwatersrand SOUTH AFRICA