title: Antibiotic prophylaxis for cesarean section.
abstract: BACKGROUND
  The single most important risk factor for postpartum maternal infection is Cesarean delivery.
  
  
  OBJECTIVE
  The objective of this review was to assess the effects of prophylactic antibiotic treatment on infectious complications in women undergoing Cesarean delivery.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register.
  
  
  METHODS
  Randomised trials comparing antibiotic prophylaxis or no treatment for both elective and non-elective Cesarean section.
  
  
  METHODS
  Two reviewers assessed trial quality and extracted data.
  
  
  RESULTS
  Sixty-six trials were included. Use of prophylactic antibiotics in women undergoing Cesarean section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after Cesarean section. The reduction in the risk of endometritis with antibiotics was similar across different patient groups. The relative risk for elective Cesarean section was 0.24, 95% confidence interval 0.11 to 0.48. The relative risk for non-elective Cesarean section was 0.30, 95% confidence interval 0.25 to 0.35. The relative risk for undefined or all patients together was 0.29, 95% confidence interval 0.26 to 0.33. Despite the large number of trials, different populations and different antibiotic regimens, there was no statistically significant heterogeneity.
  
  
  CONCLUSIONS
  The reduction of endometritis by two thirds to three quarters justifies a policy of administering prophylactic antibiotics to women undergoing elective or non-elective Cesarean section.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University Medical Centre, Hamilton Health Sciences Corporation, Room 2N29, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5. smaill@mcmaster.ca
authors.forename: F
authors.initials: F
authors.lastname: Smaill
authors.forename: G J
authors.initials: GJ
authors.lastname: Hofmeyr
mesh_terms: D019072:Antibiotic Prophylaxis; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011247:Pregnancy; D013530:Surgical Wound Infection / Q000517:prevention & control