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.
Duggal
Neena
N
Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California 95128, USA. neene.duggal@hhs.sccgov.org
Mercado
Celia
C
Daniels
Kay
K
Bujor
Alexandra
A
Caughey
Aaron B
AB
El-Sayed
Yasser Y
YY
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