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Intravenous clindamycin plus gentamicin is more effective than other antibiotics or combinations of antibiotics for treatment of womb infection after childbirth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Meconium‐stained amniotic fluid (MSAF) is the result of waste material from the fetal colon passing into the mother's amniotic cavity. Its incidence increases in post‐term pregnancies. Pregnant women with MSAF are more likely to develop maternal complications including inflammation of the fetal membranes caused by a bacterial infection (chorioamnionitis), postpartum inflammation of the lining of the uterus (endometritis) and neonatal complications such as neonatal sepsis and the need for admission to a neonatal intensive care unit (NICU). Fetal stress or hypoxia may trigger gasping fetal respirations, which results in the aspiration of meconium.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

There are various methods of delivery of placenta at caesarean section. These include placental drainage with spontaneous delivery, cord traction and manual removal. The last two methods: cord traction (usually combined with massage or expression of the uterus) and manual removal are frequently used. The review identified 15 studies involving 4694 women. Delivery of the placenta by cord traction at caesarean section has more advantages compared to manual removal. These are less endometritis; less blood loss; less decrease in haematocrit levels postoperatively; and shorter duration of hospital stay.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Surgical site infections are the third most frequently reported hospital‐ acquired infection. Women who give birth by caesarean section are exposed to the possibility of infection from their own, and external or environmental, sources of infection. Preventing infection by properly preparing the skin before incision is thus a vital part of the overall care given to women prior to caesarean birth. An antiseptic is applied to remove or reduce bacteria. These antiseptics include iodine or povidone‐iodine, alcohol, chlorhexidine and parachlorometaxylenol and can be applied as liquids or powders, scrubs, paints, swabs or on impregnated drapes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Review question: Cochrane authors reviewed available evidence from randomized controlled trials on the use of antibiotics for the treatment of pregnant women with intra‐amniotic infection (chorioamnionitis).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Chrioamnionitis is an infection of the fluid and sac surrounding the baby in the womb. This is usually managed with antibiotics and by delivering the baby. An additional method suggested is to infuse a salt solution into the womb either via a needle through the mother's abdomen (transabdominal) or a catheter via the mother's vagina (transcervical). The theory is that this may have a beneficial flushing or diluting effect on the infecting organisms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Cesarean deliveries are very common today, with almost one in three babies born by cesarean in some countries. Antibiotics are routinely given before or during the surgery to reduce the risk of infections, but some women still suffer from these complications. Between one in four and one in 10 women develop an infection of the uterus (endometritis) or a problem with their skin incision, respectively. These complications slow recovery from the surgery and may affect the mother's ability to take care of her baby. Other interventions are needed to further reduce the risk of infections of the uterus and wound problems after cesarean delivery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Bacteria live in women's vaginas and generally cause no problems. Very occasionally they infect the placenta during labour and can pass to the baby, causing an infection. These infections can occasionally make the baby very ill and very occasionally the baby might die.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

We wanted to assess whether giving antibiotics to all women undergoing operative vaginal deliveries (using vacuum suction or forceps) prevents infections in the mother without increasing other adverse outcomes in the mother and baby.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Infusing fluid into the uterus during labour may reduce fetal heart rate abnormalities and reduce caesarean sections.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Women undergoing cesarean section have a five to 20‐fold greater chance of getting an infection compared with women who give birth vaginally. These infections can be in the organs within the pelvis, around the surgical incision and sometimes the urine. The infections can be serious, and very occasionally can lead to the mother’s death. The potential benefits of reducing infection for the mother need to be balanced against any adverse effects such as nausea, vomiting, skin rash and rarely allergic reactions in the mother, and any effect of antibiotics on the baby, including thrush. This review looked at whether antibiotics are effective in preventing infection in women having a cesarean section. It also studied the effect of giving the antibiotics before or after the cord is clamped and different kinds of antibiotics. The review found 95 studies involving over 15,000 women. Routine use of antibiotics at cesarean section reduced the risk of wound and womb infections in mothers as well as the risk of serious complications of infections for the mothers by 60% to 70%. This was so whether the cesarean section was planned (elective) or not, and whether the antibiotics were given before or after clamping of the umbilical cord. The evidence to support antibiotic treatment was of moderate quality but often the way the study was done was not described well enough. None of the studies looked properly at possible adverse effects on the baby and so, although there are benefits for the mother, there is some uncertainty about whether there are any important effects on the baby.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

A woman's cervix is firm and undilated at the beginning of pregnancy, but progressively softens all the way to term. The progressive dilatation of the cervix occurs with uterine contractions during labour. Mechanical dilatation of the cervix at caesarean section before onset of labour is the artificial dilatation of the cervix performed by the surgeon using a finger, sponge forceps or other surgical instruments. Some obstetricians believe that dilating the cervix helps the drainage of blood following the birth (postpartum), thus reducing intrauterine infection or the risk of postpartum haemorrhage. Indeed, the mechanical cervical dilatation could result in contamination of the uterus by vaginal micro‐organisms and increase the risk of infections or cervical trauma. This review found three randomised controlled trials involving 735 women undergoing elective non‐labour caesarean section at more than 37 weeks' gestation. The number of women with a fever and the blood haemoglobin levels in the postoperative period were not clearly different between women who underwent cervical dilatation during caesarean section and those who did not. The incidence of infections such as wound infection, endometritis or urinary tract infection was also not clearly different. Many outcomes were reported in only one study with low numbers of women and a low power of the statistics. This meant there was insufficient evidence of mechanical dilatation of the cervix at non‐labour caesarean section for reducing postoperative morbidity.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

People who undergo surgery are at risk of developing infections, which complicate their recovery. In order to prevent these infections and reduce complications, antibiotics are sometimes given as a preventative (or prophylactic) treatment. The antibiotics are generally given approximately 60 minutes before the operation so that adequate tissue concentrations are reached before the skin is cut. For cesarean deliveries however, the effect of the antibiotic on the baby has to be considered, and for this reason antibiotics have been administered to women after the baby’s umbilical cord is clamped. This may not allow for adequate tissue penetration in the mother for the prevention of surgery‐related infections; additionally deferring antibiotics may not benefit the newborn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Antibiotics are administered to pregnant women during the second and third trimester of pregnancy (before labour) to prevent bacteria in the vagina and cervix affecting the pregnancy. Infection by some infectious organisms in a woman’s genital tract can cause health problems for the mother and her baby, and has been associated with preterm births. This review of eight randomised trials involved approximately 4300 women in their second or third trimester. We found that antibiotics did not reduce the risk of preterm prelabour rupture of the membranes (one trial, low quality of evidence), or the risk of preterm birth (six trials, highquality of evidence). Preterm delivery was reduced in pregnant women who had a previous preterm birth and an imbalance of bacteria in the vagina (bacterial vaginosis) during the current pregnancy. There was no reduction in preterm delivery in pregnant women with previous preterm birth without a bacterial imbalance during the current pregnancy (two trials). Postpartum endometritis, or infection of the uterus following birth, was reduced overall (three trials, moderate quality of evidence), as well as in a trial of high‐risk women who had a previous preterm birth (one trial, moderate quality of evidence). No reduction in neonatal illness was observed. Outcomes of interest were available in trials with high losses to follow‐up. We could not estimate the side effects of antibiotics since side effects were rare; however, antibiotics may still have serious side effects on women and their babies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Sometimes the protective bag of fluid around an unborn baby (the membranes) break when the baby is due without the onset of labour (regular uterine contractions). This is called PROM or prelabour rupture of the membranes. When this happens there is a risk of infection entering the womb (uterus) and affecting the mother and her baby. Newborn infections are rare but have the potential to cause serious harm requiring neonatal intensive care. Giving a pregnant woman antibiotics when she has PROM may reduce the risk of infections for the woman and her baby. Most women spontaneously start labour within 24 hours, so delaying induction of labour and waiting for spontaneous onset of labour (expectant management) may be a possibility. Another treatment for term PROM is to induce labour with oxytocin or prostaglandins. Women are often given antibiotics to prevent infection, but there are concerns about possible side‐effects of antibiotics, and that overuse of antibiotics can cause resistance to antibiotics so that they become less effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

BACKGROUND/AIM: To summarize the published evidence of prophylactic cefazolin for cesarean delivery given before the procedure versus at cord clamping.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Caesarean delivery increases the risk for infection compared to vaginal birth by five‐ to 20‐fold. Infections can be of the surgical incision, the lining of the uterus, and inside the pelvis. Clinicians seek to prevent these infections by different measures including prophylactic (preventative) antibiotics.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

The authors concluded that mechanical agents for cervical ripening were associated with significantly increased maternal and neonatal infections compared with pharmacological agents alone. Despite the inability to fully interpret trial quality, the authors' conclusion reflects the evidence presented and appears to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

The primary audience for this guideline is health professionals who are responsible for developing national and local health protocols and policies, as well as managers of maternal and child health programmes and policy-makers in all settings. The guideline will also be useful to those directly providing care to pregnant women, including obstetricians, midwives, nurses and general practitioners. The information in this guideline will be useful for developing job aids and tools for both pre- and inservice training of health workers to enhance their delivery of care to prevent and treat maternal peripartum infections.

World Health Organization.

Version: 2015

This guidance is a partial update of NICE clinical guideline 13 (published April 2004) and will replace it.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 2011

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