Re: Antibiotics and timing of surgery
From: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au)
Mon Mar 20 19:30:41 2006
Beware - none of the conclusions is statistically significant as the
confidence limits all cross unity. It would be necessary to repeat the
study with many more patients recruited to know for sure!
Steve
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
Ramirez
Sent: Tuesday, 21 March 2006 9:58 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Antibiotics and timing of surgery
You are right...I have always given them after cord clamping - except
for GBS - of course.. I'll ask ours what they think...
Ef
> At Mon, 20 Mar 2006, Dr Eberhard Lisse wrote:
>
>Ef,
>
>It's not the maternal morbidity that is the issue, some Pediatricians
>feel that given befoe you clamp the cord might interfere with their
>diagnostics later on. Our own Peds who really know what they are doing,
>don't care one bit. Neither do I then.
>
>el
>
>on 3/20/06 3:51 PM Efrain Ramirez said the following:
>> Timing of prophylactic antibiotic administration in the uninfected
>> laboring gravida: a randomized clinical trial.
>>
>> Thigpen BD, Hood WA, Chauhan S, Bufkin L, Bofill J, Magann E,
>> Morrison JC
>>
>> Am J Obstet Gynecol (2005 Jun) 192(6):1864-8; discussion 1868-71
ISSN:
>> 0002-9378
>>
>> Abstract
>>
>> OBJECTIVE: The purpose of this prospective study was to determine
>> whether the timing of prophylactic antibiotics at cesarean delivery
>> influences maternal/neonatal infectious morbidity.
>>
>> STUDY DESIGN: In this double-blind placebo-controlled trial,
>> cefazolin was given at skin incision (group A) or at cord clamping
(group B).
>> Patients were eligible for the trial if they had labored and required
>> a cesarean delivery.
>>
>> RESULTS: Over
>>
>> Top of Abstract
>>
>> a 30-month period 303 patients with singleton pregnancies entered the
>> trial; 153-group A, 149-group B. Demographics, indication for
>> cesarean delivery (P = .54), and operative time (P = .999), as well
>> as rates of endometritis (RR 0.67, 95% CI 0.42-1.07), wound infection
>> (RR 0.84, 95% CI 0.45-1.55), neonatal sepis (RR 1.28, 95% CI
>> 0.91-1.79), and NICU admissions (RR 1.28, 95% CI 0.91-1.79) were
>> similar between the 2 groups.
>>
>> CONCLUSION: There was no difference in maternal infectious morbidity
>> whether antibiotics were given before skin incision or at cord
clamping.
>>
>> At Mon, 20 Mar 2006, Elrod, Darryl G MAJ 48 MDOS/SGOBO wrote:
>>> We are still giving ancef at cord clamp.
>>>
>>> Glen
>>>
>>> //SIGNED//
>>>
>>> D. Glen Elrod, Maj., USAF, MC
>>>
>>> Obstetrician/Gynecologist
>>>
>>> Chief of Obstetrics
>>>
>>> 48 MDOS/SGOBO
>>>
>>> RAF Lakenheath, England
>>>
>>> Telephone DSN: 314-226-8130
>>>
>>> Comm: +44 (0) 1638 52 8130
>>>
>>> Notice of Confidentiality
>>> Under the Privacy Act of 1974, you must safeguard all information
>>> reflected on this e-mail and, if applicable, all attachments.
>>> Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131,
>>> AFI 37-132, AFI 33-219, and PL 93-579"
>>> This e-mail message including any attachments is for the sole use of
>>> the intended recipient(s) and may contain confidential and
>>> privileged information. Any unauthorized review, use, disclosure or
>>> distribution is prohibited. If you are not the intended recipient,
>>> please contact the sender by reply e-mail and destroy all copies of
the original message.
>>> Any questions pertaining to disclosure should be directed to the
>>> privacy officer.
>>>
>>> -----Original Message-----
>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of S
>>> Osterling M.D.
>>> Sent: Friday, March 17, 2006 6:44 PM
>>> To: Multiple recipients of list OB-GYN-L
>>> Subject: Antibiotics and timing of surgery
>>>
>>> Many of your gyn ORs are being evaluated for timeliness of
antibiotics.
>>> The standard is within one hour of the incision.
>>>
>>> The big exception to this is the c-section. Most of us give 1 gram
>>> kefzol at cord clamp. This is done at the request of pediatrics.
>>>
>>> Is anyone on the list giving the antibiotics prior to incision for
>>> "better" prophylaxis?
>>>
>>> S. Osterling M.D.
>>> California
>>
>> --
>> " The greatest obstacle to knowledge is not ignorance, it is the
>> illusion of knowledge." Daniel J. Boorstin - Historian
--
" The greatest obstacle to knowledge is not ignorance, it is the
illusion of knowledge." Daniel J. Boorstin - Historian
