title: Timing of perioperative antibiotics for cesarean delivery: a metaanalysis.
abstract: OBJECTIVE
  The purpose of this study was to summarize the available evidence on timing of perioperative antibiotics for cesarean delivery.
  
  
  METHODS
  We searched the literature for studies that compare prophylactic antibiotics for cesarean delivery that are given before the procedure vs at cord clamping. Only randomized controlled trials were included.
  
  
  RESULTS
  Preoperative administration significantly reduced the risk of postpartum endometritis (relative risk [RR], 0.47; 95% CI, 0.26-0.85; P = .012) and total infectious morbidity (RR, 0.50; 95% CI, 0.33-0.78; P = .002). There was a trend toward lower risk of wound infection (RR, 0.60; 95% CI, 0.30-1.21; P = .15). Preoperative administration of antibiotics did not significantly affect suspected neonatal sepsis that requires a workup (RR, 1; 95% CI, 0.70-1.42), proven sepsis (RR, 0.93; 95% CI, 0.45-1.96), or neonatal intensive care unit admissions (RR, 1.07 95% CI, 0.51-2.24). There was no significant heterogeneity between the randomized controlled trials.
  
  
  CONCLUSIONS
  There is strong evidence that antibiotic prophylaxis for cesarean delivery that is given before skin incision, rather than after cord clamping, decreases the incidence of postpartum endometritis and total infectious morbidities, without affecting neonatal outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555-0587, USA.
authors.forename: Maged M
authors.initials: MM
authors.lastname: Costantine
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rahman
authors.forename: Labib
authors.initials: L
authors.lastname: Ghulmiyah
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Byers
authors.forename: Monica
authors.initials: M
authors.lastname: Longo
authors.forename: Tony
authors.initials: T
authors.lastname: Wen
authors.forename: Gary D V
authors.initials: GD
authors.lastname: Hankins
authors.forename: George R
authors.initials: GR
authors.lastname: Saade
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002585:Cesarean Section; D004716:Endometritis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000517:prevention & control