All Women Need Antibiotics One Hour Before Cesarean Delivery

As cited, all pregnant women should be given antibiotics before having a cesarean delivery to help prevent infections, according to new recommendations issued today by The American College of Obstetricians and Gynecologists. The College says that the antibiotics should be given within one hour of the start of surgery for maximum effectiveness.

Infection is the most common complication of cesarean delivery and can occur in 10% to 40% of women who have a cesarean compared with 1% to 3% of women who deliver vaginally. Although antibiotics have been given to women having cesareans to reduce their risk of postoperative infections, they have generally been given after the baby was born and the umbilical cord was clamped. This was based on concern that the antibiotics that made it into the baby's bloodstream from the mother would interfere with newborn lab tests or could lead to antibiotic-resistant infections.

"Based on the latest data, prophylactic antibiotics given to pregnant women before a cesarean significantly reduce maternal infection and do not appear to harm newborns," said William H. Barth, Jr, MD, chair of The College's Committee on Obstetric Practice. "We're recommending that all women who undergo cesarean get a preventive course of antibiotics before the surgery starts. Ideally, this should happen within 60 minutes of surgery." An exception to this, Dr. Barth noted, are pregnant women who are already taking appropriate antibiotics for another problem, such as chorioamnionitis (infection of the membranes surrounding the fetus). Women who need an emergency cesarean should be given antibiotics as soon as possible.

"Anytime you have invasive surgery, you have an increased risk of developing an infection at the incision site," said Dr. Barth. This new recommendation should help reduce the overall rate of cesarean-related infections, Dr. Barth added.

Committee Opinion #465, "Antimicrobial Prophylaxis for Cesarean Delivery: Timing of Administration," is published in the September 2010 issue of Obstetrics & Gynecology.