Evaluating Pre-Incision Versus Post Umbilical Cord Clamping Antibiotic Prophylaxis in the Prevention of Post Caesarean Section Infections in a Nigerian Specialist Teaching Hospital

Ajekweneh A.1, Eifediyi R.A.1, Okome G.B.O.1, Momoh M1, Ikheloa J.1, Okogbenin S.1, Affussim C.O.2, Alika S.4, Olowo S.3 and Ajekweneh V.1

1Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria; 2Department of Family Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo state, Nigeria; 3Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo state, Nigeria; 4Department of Medical Microbiology, Irrua Specialist Teaching Hospital, Irrua, Edo state, Nigeria

DOI: http://dx.doi.org/10.14205/2309-4400.2015.03.01.4

Abstract: Introduction: Caesarean delivery is the single most important factor associated with post partum infection and carries a 5-20 fold increased risk of infection compared to vaginal delivery. With the increase in Caesarean delivery rates worldwide, post-Caesarean delivery infections are likely to become a significant health and economic burden. Pre-incision antibiotic prophylaxis prevents maternal infectious morbidity without prejudice to neonatal infectious morbidity. This Study compared pre-incision versus post-umbilical cord clamping antibiotic prophylaxis in the prevention of post caesarean section infection.

Methods: This is an interventional, single blinded, two-armed, randomized, single centre study using amoxicillin/ clavulanic acid plus metronidazole. One hundred and fifty patients that met the inclusion criteria were randomised into pre-incision and post umbilical clamp arm with seventy five patients in each study arm. Patients were followed up for six weeks postpartum.

Results: The overall post-operative fever rate was 10.7% with 4.00% in pre-incision and 6.67% in post umbilical clamp group (fisher’s exact test of 0.428 and cumulative incidence relative risk of 0.533 (95%CL: 0.194-1.64). Two percent and 4.67% of studied population developed endometritis in pre-incision and post umbilical groups respectively (fisher’s exact test of 0.327 and cumulative incidence relative risk of 0.44(95%CL: 0.101-1.625). Superficial wound infection occurred in 2.00% of the studied population in pre-incision group and 3.33% in post umbilical group. The overall wound infection prevalence rate was therefore 5.33% (fisher’s exact test of 0.719 and cumulative incidence relative risk of 0.66 (95%CL: 0.395-7.446). Staphylococcus aureus was the commonest isolate. No significant difference between the study groups in this study in terms of neonatal outcome.

Conclusion/Recommendation: Antimicrobial agent for surgical prophylaxis could prevent surgical site infection and related morbidity, reduce the duration of hospital stay and therefore cost of health care. Post caesarean section infectious surveillance should be encouraged in all delivery units.

Keywords: Caesarean section, Wound infection, antibiotic prophylaxis.