Drug Therapy During Labor and Delivery, Part 1

Gerald G. Briggs; Stephanie R. Wan


Am J Health Syst Pharm. 2006;63(11):1038-1047. 

In This Article

Prevention of Postpartum Endometritis

Endometritis is an infection of the endometrium or decidua, with extension into the myometrium and parametrial tissues. It is the most common cause of fever during the postpartum period, occurring in approximately 1-3% of women who deliver vaginally and in about 20% of those who deliver by cesarean section.[31] The rate of postpartum endometritis has been reported as an average of 35-50%[32,33] and as high as 85-90%[34] in those patients who did not receive perioperative antibiotic prophylaxis prior to cesarean delivery.

Cefazolin 1-2 g i.v.[35] or by uterine irrigation[36] immediately after cord clamping is the preferred agent. Ampicillin 1-2 g i.v. is an alternative choice. Some investigators have reported the emergence of enterococci in up to 20% of women in cases of cephalosporin prophylaxis failure[37]; nevertheless, cefazolin is preferred due to its longer half-life and lower allergic and anaphylactic risk. Broader spectrum second- and third-generation cephalosporins are no more effective but carry a higher risk of pseudomembranous colitis[38] and are more expensive.[30] In women with cephalosporin allergy or penicillin allergy at high risk for anaphylaxis, clindamycin 900 mg i.v. plus gentamicin 1.5 mg/kg i.v. at cord clamping is an alternative.

In women undergoing scheduled, elective repeat cesarean section without a trial of labor or additional risk factors, routine antibiotic prophylaxis is not recommended. Risk factors include prolonged (>12 hours) rupture of membranes, active labor, diabetes, preexisting infections (e.g., urinary tract infection or chorioamnionitis), or expected duration of surgery of over 1 hour. If there are risk factors, antibiotic prophylaxis before scheduled cesarean section is based on clinical judgment. In nonelective and high-risk cesarean sections with any of the above risk factors, antibiotic prophylaxis is recommended.[35]


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