Antibiotic prophylaxis at Cesarean delivery.
OBJECTIVE
Our aim was to compare the efficacy of ampicillin, cefotetan, and ampicillin/sulbactam in the prevention of post-Cesarean endomyometritis.


METHODS
Consenting patients undergoing Cesarean delivery at the University of Louisville Hospital were enrolled in a prospective, double-blinded randomization to receive either ampicillin/sulbactam (Group 1), cefotetan (Group 2), or ampicillin (Group 3) single dose antibiotic prophylaxis following umbilical cord clamping. The primary outcome variable was the frequency of endomyometritis in the respective groups.


RESULTS
Among 301 randomized patients, outcome data was available for 298 patients. Fourteen patients (4.7%), all of whom underwent non-elective Cesarean delivery, developed endomyometritis. The frequency of endomyometritis was not different among groups: Group 1, 4/101 (4%); Group 2, 4/96 (4.2%); and Group 3, 6/101 (5.9%). Wound infections were infrequently observed 4/298 (1.3%) without significant differences among groups. Stepwise discriminative analysis identified only last cervical dilatation as a significant predictor of endomyometritis (P = 0.006).


CONCLUSIONS
Post-Cesarean endomyometritis occurs infrequently following single dose antibiotic prophylaxis after umbilical cord clamping. An advantage of broader spectrum antibiotics over ampicillin was not demonstrated.
Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Kentucky, USA.
J A
JA
Spinnato
B
B
Youkilis
V D
VD
Cook
M
M
Pietrantoni
A L
AL
Clark
S A
SA
Gall
D000328:Adult; D000667:Ampicillin / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D015313:Cefotetan / Q000008:administration & dosage / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects; D004311:Double-Blind Method; D004716:Endometritis / Q000517:prevention & control; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D011247:Pregnancy; D011446:Prospective Studies; D013407:Sulbactam / Q000008:administration & dosage / Q000627:therapeutic use
D015313:Cefotetan; D000667:Ampicillin; D013407:Sulbactam