Antibiotic prophylaxis for prevention of postpartum perineal wound complications: A randomized controlled trial

Neena Duggal, Celia Mercado, Kay Daniels, Alexandra Bujor, Aaron Caughey, Yasser Y. El-Sayed

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

OBJECTIVE:: To estimate whether prophylactic antibiotics at the time of repair of third- or fourth-degree perineal tears after vaginal delivery prevent wound infection and breakdown. METHODS:: This was a prospective, randomized, placebo-controlled study. Patients who sustained third- or fourth-degree perineal tears after a vaginal delivery were recruited for the study. Each patient was given a single intravenous dose of a second-generation cephalosporin (cefotetan or cefoxitin) or placebo before repair of third- or fourth-degree perineal tears. Obstetricians and patients were blinded to study drug. The perineum was inspected for evidence of infection or breakdown at discharge from the hospital and at 2 weeks postpartum. Primary end points were gross disruption or purulent discharge at site of perineal repair by 2 weeks postpartum. RESULTS:: One hundred forty-seven patients were recruited for the study. Of these, 83 patients received placebo and 64 patients received antibiotics. Forty patients (27.2%) did not return for their 2-week appointment. Of the patients seen at 2 weeks postpartum, 4 of 49 (8.2%) patients who received antibiotics and 14 of 58 (24.1%) patients who received placebo developed a perineal wound complication (P=.037). There were no differences between groups in parity, incidence of diabetes, operative delivery, or third-degree compared with fourth-degree lacerations. CONCLUSION:: By 2 weeks postpartum, patients who received prophylactic antibiotics at the time of third- or fourth-degree laceration repair had a lower rate of perineal wound complications than patients who received placebo.

Original languageEnglish (US)
Pages (from-to)1268-1273
Number of pages6
JournalObstetrics and Gynecology
Volume111
Issue number6
DOIs
StatePublished - Jun 2008
Externally publishedYes

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Antibiotic Prophylaxis
Postpartum Period
Randomized Controlled Trials
Wounds and Injuries
Placebos
Tears
Anti-Bacterial Agents
Lacerations
Cefotetan
Cefoxitin
Perineum
Wound Infection
Cephalosporins
Parity
Appointments and Schedules

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Antibiotic prophylaxis for prevention of postpartum perineal wound complications : A randomized controlled trial. / Duggal, Neena; Mercado, Celia; Daniels, Kay; Bujor, Alexandra; Caughey, Aaron; El-Sayed, Yasser Y.

In: Obstetrics and Gynecology, Vol. 111, No. 6, 06.2008, p. 1268-1273.

Research output: Contribution to journalArticle

Duggal, Neena ; Mercado, Celia ; Daniels, Kay ; Bujor, Alexandra ; Caughey, Aaron ; El-Sayed, Yasser Y. / Antibiotic prophylaxis for prevention of postpartum perineal wound complications : A randomized controlled trial. In: Obstetrics and Gynecology. 2008 ; Vol. 111, No. 6. pp. 1268-1273.
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abstract = "OBJECTIVE:: To estimate whether prophylactic antibiotics at the time of repair of third- or fourth-degree perineal tears after vaginal delivery prevent wound infection and breakdown. METHODS:: This was a prospective, randomized, placebo-controlled study. Patients who sustained third- or fourth-degree perineal tears after a vaginal delivery were recruited for the study. Each patient was given a single intravenous dose of a second-generation cephalosporin (cefotetan or cefoxitin) or placebo before repair of third- or fourth-degree perineal tears. Obstetricians and patients were blinded to study drug. The perineum was inspected for evidence of infection or breakdown at discharge from the hospital and at 2 weeks postpartum. Primary end points were gross disruption or purulent discharge at site of perineal repair by 2 weeks postpartum. RESULTS:: One hundred forty-seven patients were recruited for the study. Of these, 83 patients received placebo and 64 patients received antibiotics. Forty patients (27.2{\%}) did not return for their 2-week appointment. Of the patients seen at 2 weeks postpartum, 4 of 49 (8.2{\%}) patients who received antibiotics and 14 of 58 (24.1{\%}) patients who received placebo developed a perineal wound complication (P=.037). There were no differences between groups in parity, incidence of diabetes, operative delivery, or third-degree compared with fourth-degree lacerations. CONCLUSION:: By 2 weeks postpartum, patients who received prophylactic antibiotics at the time of third- or fourth-degree laceration repair had a lower rate of perineal wound complications than patients who received placebo.",
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