Background During caesarean section, prophylactic antibiotics are usually given after cord clamping (instead of prior to skin incision) for fear of antibiotics having adverse effects on the newborn and promoting resistant strains.
Objective To compare efficacy of intravenous cefazoline administered during caesarean section either before skin incision or after cord clamping, on mother and newborn.
Setting Tertiary care perinatal centre in south India.
Methods Term gestation mothers posted for caesarean section were randomised to receive two medicinesIV cefazoline/ placeboone prior to skin incision, one after cord clamping. Mothers and babies were monitored for evidence of infection or adverse events during hospital stay. They were reviewed at 45 days to look for complications.
Results 1106 mothers were recruited. At baseline, mothers and babies in both groups were similar. The mean (SD) duration of hospital stay for mothers in both groups was 5.3(1.5) days. Mothers who received antibiotics prior to skin incision had less post operative complications compared to mothers who received antibiotics after cord clamping (p = 0.000). Mothers who received antibiotics after cord clamping stayed longer in hospital (p = 0.008). Babies in both groups had similar rates of nursery admissions, sepsis, NEC and hospital readmission following discharge.
Conclusions IV antibiotics can be safely administered to mothers prior to skin incision which decreases postoperative infectious morbidity without adverse effects in babies.