A Safer C-Section

C-section infection rate drops when antibiotics are offered an hour before procedure

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Pregnant women who deliver by cesarean section usually receive antibiotics after the baby’s umbilical cord is clamped. But could meds before the procedure reduce the risk of infection?

A recent study has found evidence that they might. The study found that providing the women with antibiotics an hour before the procedure led to a reduction in infection rates.

The researchers believe antibiotics an hour before C-section reduce infection risk.

"Ask your OB/GYN about medications during birthing."

The study was led by by Nupur D. Kittur, PhD, MPH, from the Department of Medicine and the Department of Obstetrics and Gynecology at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis.

Dr. Kittur and her colleagues studied 8,668 women who underwent C-sections during an 8-year period at Barnes-Jewish Hospital in St. Louis, Missouri.

Their average age was 26, and about one third of the women were overweight or obese.

A total of 303 of the women — 3.5 percent of the total — experienced an infection at the site of their surgery.

The hospital had implemented various policies to reduce infection rates between January, 2003 and December, 2010 — the study period. The researchers looked at these policies and evaluated the impact each one had on infection rates.

One policy, begun in January of 2004, was giving women antibiotics an hour before a C section.

When the researchers crunched the numbers, they found that this policy of giving women antibiotics an hour before their procedure instead of during the cord clamp reduced the rate of infections by 48 percent.

This policy would translate to 5.4 fewer infections occurring per 100 women getting a C section.

In 2003, the rate of infections at the hospital was about 9 or 10 infections per 100 C section deliveries. After the policy, the infection rate began decreasing, reaching about two infections per 100 deliveries by 2010.

The rapid reduction in infection rates occurred even though the number of overweight women delivering by C section increased as the the study continued. Being overweight is a risk factor for infection.

The American College of Obstetricians and Gynecologists recommended this same policy — antibiotics an hour before a C section — in 2011.

"Until recently, standard practice in the U.S. was to give antibiotics when the baby was delivered, after the umbilical cord was clamped," said David K. Warren, MD, an infectious disease specialist who co-authored the study. "It was always a theoretical concern that giving antibiotics might somehow mask sepsis [infection] in the neonate [newborn], but there have been several recent studies showing that this was not an issue."

Dr. Warren is referring to the concern that giving antibiotics before the procedure might make it more difficult to identify whether the newborn had an infection since the antibiotics could hide the symptoms. But there is no evidence that this ever actually happened.

Other risk factors for getting an infection during a C section include being very young or very old for pregnancy, being overweight, having the woman's water break early, having a long surgery and using staples to close the wound.

The study was published August 2 in the journal Obstetrics and Gynecology. The research was funded by the Centers for Disease Control and Prevention Epicenter Grant and Barnes-Jewish Hospital Epidemiology and Infection Prevention Department. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
August 15, 2012
Last Updated:
August 17, 2012