• F Smaill and G J Hofmeyr.
• Department of Pathology and Molecular Medicine, McMaster University Medical Centre, Hamilton Health Sciences Corporation, Room 2N29, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5. smaill@mcmaster.ca
• Cochrane Db Syst Rev. 2000 Jan 1 (2): CD000933.

BackgroundThe single most important risk factor for postpartum maternal infection is Cesarean delivery.ObjectivesThe objective of this review was to assess the effects of prophylactic antibiotic treatment on infectious complications in women undergoing Cesarean delivery.Search StrategyWe searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register.Selection CriteriaRandomised trials comparing antibiotic prophylaxis or no treatment for both elective and non-elective Cesarean section.Data Collection And AnalysisTwo reviewers assessed trial quality and extracted data.Main ResultsSixty-six trials were included. Use of prophylactic antibiotics in women undergoing Cesarean section substantially reduced the incidence of episodes of fever, endometritis, wound infection, urinary tract infection and serious infection after Cesarean section. The reduction in the risk of endometritis with antibiotics was similar across different patient groups. The relative risk for elective Cesarean section was 0.24, 95% confidence interval 0.11 to 0.48. The relative risk for non-elective Cesarean section was 0.30, 95% confidence interval 0.25 to 0.35. The relative risk for undefined or all patients together was 0.29, 95% confidence interval 0.26 to 0.33. Despite the large number of trials, different populations and different antibiotic regimens, there was no statistically significant heterogeneity.Reviewer's ConclusionsThe reduction of endometritis by two thirds to three quarters justifies a policy of administering prophylactic antibiotics to women undergoing elective or non-elective Cesarean section.

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