Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Antibiotic Prophylaxis for Operative Vaginal Delivery

 

Am Fam Physician. 2020 Oct 1;102(7):online.

image

Details for This Review

 Enlarge     Print

ANTIBIOTIC PROPHYLAXIS FOR OPERATIVE VAGINAL DELIVERY

BenefitsHarms

1 in 10 did not have a wound breakdown

None were harmed

1 in 26 did not develop a superficial perineal wound

1 in 41 did not develop a deep perineal wound

1 in 121 did not develop a serious infectious complication

ANTIBIOTIC PROPHYLAXIS FOR OPERATIVE VAGINAL DELIVERY

BenefitsHarms

1 in 10 did not have a wound breakdown

None were harmed

1 in 26 did not develop a superficial perineal wound

1 in 41 did not develop a deep perineal wound

1 in 121 did not develop a serious infectious complication

Study Population: Women who underwent operative vaginal delivery

Efficacy End Points: Reduction in infectious postpartum morbidities such as wound infection, wound breakdown, endometritis, and sepsis in women with less than a third-degree tear (antibiotics are commonly administered for third- or fourth-degree tears)

Harm End Points: Adverse reaction to antibiotic therapy

Narrative: Operative vaginal birth is used to achieve or expedite safe delivery for maternal or fetal indications, and is accomplished using traction on the fetal head through the application of forceps or a vacuum extractor.1 Despite success in achieving vaginal birth, operative vaginal deliveries may result in an increased incidence of postpartum infections and maternal readmissions when compared with spontaneous vaginal deliveries.2 Despite these potential complications, current guidelines from the World Health Organization do not recommend routine antibiotic prophylaxis for operative vaginal birth because of insufficient evidence of effectiveness.3

This Cochrane review included two randomized controlled trials with a total of 3,813 pregnant women undergoing operative vaginal delivery using a vacuum or forceps.2

The ANODE trial was a blinded, randomized, multicenter trial conducted in the United Kingdom that consisted of 3,420 women. The trial compared a single dose of intravenous amoxicillin/clavulanate (Augmentin) with placebo.2 The other study involved 393 women in the United States and compared intravenous cefotetan (Cefotan) with no treatment.4

Benefits of antibiotic therapy included a reduction in superficial (epidermis only) perineal wounds (relative risk [RR] = 0.53; 95% CI, 0.40 to 0.69; number needed to treat [NNT] = 26; high-certainty evidence); reduction in deep (muscle/fascial involvement) perineal wounds (RR = 0.46; 95% CI, 0.31 to 0.69; NNT = 41; high-certainty

Author disclosure: No relevant financial affiliations.

References

show all references

1. Operative vaginal birth: ACOG Practice Bulletin, Number 219. Obstet Gynecol. 2020;135(4):e149–e159....

2. Liabsuetrakul T, Choobun T, Peeyananjarassri K, et al. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database Syst Rev. 2020;(3):CD004455.

3. WHO recommendation against routine antibiotic prophylaxis for women undergoing operative vaginal birth (September 2015). The WHO Reproductive Health Library; Geneva: World Health Organization. Accessed September 3, 2020. https://bit.ly/2Zkfggz

4. Heitmann JA, Benrubi GI. Efficacy of prophylactic antibiotics for the prevention of endomyometritis after forceps delivery. South Med J. 1989;82(8):960–962.

5. Knight M, Chiocchia V, Partlett C, et al.; ANODE collaborative group. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial [published correction appears in Lancet. 2019;393(10189):2394]. Lancet. 2019;393(10189):2395–2403.

6. Wilkie GL, Saadeh M, Robinson JN, et al. Risk factors for poor perineal outcome after operative vaginal delivery. J Perinatol. 2018;38(12):1625–1630.

 

 

Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in Pubmed

MOST RECENT ISSUE


Dec 1, 2020

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article