Re: Curious about your opinions about this article
From: R. Daniel Braun (rd.braun@gmail.com)
Sun Mar 18 08:56:45 2007
I've always said that it made no sense for pregnancy to be diferent from non
pregnancy in this particular case.
Dan
On 3/17/07, Kim E. Goldman <goldman@calweb.com> wrote:
>
> In every other field the idea of single dose preoperative antibiotics for
> prophylaxis is well established (see work by Polk et. al.) thus this makes
> good sense. Not being an OB I would have to ask a) what is the time from
> skin incision to delivery for most c sections (relatively short I would
> think) b) how much cefazolin crosses the placenta and what is a significant
> dose for the neonate. You need the antibiotics to be at the site of
> incision BEFORE incision for true prophylaxis.
>
> Just my two cents...from a surgeon at the other end of the body <g>!
>
> Kim
>
> On Mar 17, 2007, at 10:42 PM, GIN11153@aol.com wrote:
>
> http://www.obgynnews.com/article/PIIS0029743707701623/fulltext
>
> SAN FRANCISCO — Preoperative prophylaxis with cefazolin more effectively
> prevents postcesarean infections than does intraoperative administration of
> the antibiotic, a prospective study has shown.
>
> Additionally, giving the drug prior to skin incision does not increase
> neonatal infectious morbidity or sepsis evaluation, Dr. Scott Sullivan
> reported at the annual meeting of the Society for Maternal-Fetal Medicine..
>
> The efficacy of single-dose antibiotic prophylaxis for reducing the risk
> of postcesarean infection is well established, "but controversy exists
> regarding the most effective timing of prophylaxis," said Dr. Sullivan of
> the Medical University of South Carolina in Charleston. "It's common
> obstetrical practice in the United States to delay antibiotic prophylaxis
> for cesarean sections until the neonate is delivered, typically at the time
> of cord clamping."
>
> Preoperative administration of antibiotics has been avoided "largely due
> to theoretical neonatal risks, including increased neonatal resistance,
> increased neonatal sepsis, and increased septic work-ups," he said.
>
> In the current investigation of 357 women undergoing cesarean section, 175
> were randomized to receive 1 g of cefazolin 15–60 minutes prior to skin
> incision and placebo at time of cord clamping and 182 received placebo prior
> to incision and 1 g of cefazolin at the time of cord clamping. Eight of the
> 357 patients were lost to follow-up after hospital discharge but were
> included in the final analysis, said Dr. Sullivan.
>
> The study participants were older than 18 years and most were actively in
> labor at the time of surgery, although some were not in labor but required
> surgery because of breech presentation or other indications, Dr. Sullivan
> said.
>
> Women with cephalosporin allergy were excluded from the study, as were
> those already on antibiotics and those requiring emergency cesarean surgery.
> There were no differences between the two groups with respect to maternal
> demographic or obstetric variables.
>
> Patients were followed for up to 6 weeks post partum for evidence of
> infectious morbidity. "Endomyometritis and wound infections were diagnosed
> using established clinical criteria, and other maternal infections were
> diagnosed via positive culture," Dr. Sullivan said.
>
> An analysis of infectious morbidity showed significant decreases in total
> postcesarean infections and endomyometritis, as well as a trend toward
> decreased wound infections, in the preoperative prophylaxis group, compared
> with the intraoperative group, Dr. Sullivan said. Specifically, in the
> preoperative prophylaxis group, there were two cases of endomyometritis,
> five wound infections, and one additional infection.
>
> In the intraoperative prophylaxis group, 10 patients each experienced
> endomyometritis and wound infections, and 1 patient experienced an
> additional infection.
>
> Because the control group had a relatively higher number of medical
> complications and mean operative times, the investigators performed a
> precautionary logistic regression analysis to control for this effect. "The
> adjusted odds ratio was not significantly different," Dr. Sullivan noted.
>
> In terms of neonatal outcomes, there were no differences in neonatal
> sepsis, neonatal septic work-ups, rates of neonatal intensive care unit or
> level 2 admissions, or total length of stay between the two groups. Although
> there were significantly fewer NICU admission days in the preoperative
> group, "this finding cannot be attributed to the prophylaxis timing without
> further investigation," Dr. Sullivan said.
>
> "There were only two cases of early-onset neonatal sepsis—one in each
> group—and there was no evidence of different resistance patterns in any of
> the organisms," Dr. Sullivan said.
>
> The generalizability of the study findings may be limited by the fact that
> the populations of both groups were more overweight, more likely to be
> diabetic, had more medical complications, and included more minorities than
> did a typical obstetric population.
>
> Additionally, "the cesarean sections were performed by or with resident
> surgeons of varying levels of experience, resulting in longer mean operative
> time and higher mean estimated blood loss than would have been expected,"
> Dr. Sullivan said.
>
> Gail Neuman RNC CPHW
> student midwife and student nurse practitioner
> certified high risk OB/OB legal consultant
> Perinatal Nurse Associates
> Santa Ana, CA
>
> ------------------------------
> AOL now offers free email to everyone. Find out more about what's free
> ------------------------------
> from AOL at *AOL.com* <http://www.aol.com/?ncid=3DAOLAOF00020000000339>.
> ------------------------------
>
--
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"The way to health is an aromatic bath and scented massage everyday"..
Hippocrates
