title: Timing of Antibiotic Prophylaxis in Elective Caesarean Delivery: A Multi-Center Randomized Controlled Trial and Meta-Analysis.
abstract: OBJECTIVE
  To compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery.
  
  
  METHODS
  We conducted a randomized open-label controlled trial with two parallel arms at three hospitals in western China. Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others received antibiotics after umbilical cords clamping. For the meta-analysis, studies were identified from the database of PUBMED, Cochrane Library and EMbase and assessed using the Cochrane risk of bias tool.
  
  
  RESULTS
  Four hundred and ten patients were randomized to receive antibiotics before skin incision (n = 205) or after umbilical cords clamping (n = 205). There was no difference in the incidence of postpartum endometritis (RR = 0.34, 95% CI 0.04 to 3.24), wound infection (RR = 3.06, 95% CI 0.13 to 74.69) and total puerperal morbidity (RR = 1.02, 95% CI 0.47 to 2.22). No increase in the incidence of neonatal sepsis (RR = 0.34, 95% CI 0.04 to 3.24), septic workup (RR = 0.41, 95% CI 0.08 to 2.07), or intermediate NICU admission (RR = 0.73, 95% CI 0.24 to 2.26) was observed. The meta-analysis involving nine RCTs showed that no statistically significant difference was found in terms of the risk of postpartum endometritis (RR = 0.73, 95% CI 0.39, 1.36), wound infection (RR = 0.80, 95%CI 0.55, 1.17), or puerperal morbidity (RR = 0.89, 95% CI 0.70, 1.13). No increase in the incidence of neonatal sepsis (RR = 0.65, 95% CI 0.35 to 1.20), septic workup (RR = 0.88, 95% CI 0.50 to 1.54), or intermediate NICU admission (RR = 0.91, 95% CI 0.70 to 1.18) was observed.
  
  
  CONCLUSIONS
  For elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up.
  
  
  BACKGROUND
  Chinese Clinical Trial Registry ChiCTR-TRC-11001853.
authors.affiliation: Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
authors.forename: Lingli
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Obstetric & Gynecologic, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
authors.forename: Xinghui
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Obstetric & Gynecologic, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Pharmacy, Nanchong Central Hospital, Nanchong, Sichuan, China.
authors.forename: Zhiyou
authors.initials: Z
authors.lastname: Zeng
authors.affiliation: Department of Pharmacy, Nanchong Central Hospital, Nanchong, Sichuan, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.affiliation: The Chinese Cochrane Center, West China Hospital, Chengdu, Sichuan, China.
authors.forename: Guanjian
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Obstetric & Gynecologic, Suining Central Hospital, Suining, Sichuan, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods; D002585:Cesarean Section / Q000009:adverse effects*; D002681:China; D003250:Constriction; D004716:Endometritis / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D049590:Postpartum Period / Q000187:drug effects; D011247:Pregnancy; D018805:Sepsis / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014470:Umbilical Cord / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents