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


CONCLUSIONS
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.


BACKGROUND
ClinicalTrials.gov, www.clincaltrials.gov, NCT00186082.


METHODS
I.
Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California 95128, USA. neene.duggal@hhs.sccgov.org
Neena
N
Duggal
Celia
C
Mercado
Kay
K
Daniels
Alexandra
A
Bujor
Aaron B
AB
Caughey
Yasser Y
YY
El-Sayed
D000328:Adult; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011446:Prospective Studies; D011645:Puerperal Infection / Q000517:prevention & control*; D014946:Wound Infection / Q000517:prevention & control*
D002511:Cephalosporins