Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth

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Authors

  • Pranom Buppasiri,

    Corresponding author
    1. Khon Kaen University, Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen, Khon Kaen, Thailand
    • Pranom Buppasiri, Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Faculty of Medicine, Khon Kaen, Khon Kaen, 40002, Thailand. bprano@kku.ac.th.

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  • Pisake Lumbiganon,

    1. Khon Kaen University, Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen, Khon Kaen, Thailand
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  • Jadsada Thinkhamrop,

    1. Khon Kaen University, Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen, Khon Kaen, Thailand
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  • Bandit Thinkhamrop

    1. Khon Kaen University, Department of Demography and Biostatistics, Khon Kaen, Thailand
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Abstract

Background

One to eight per cent of women suffer third-degree perineal tear (anal sphincter injury) and fourth-degree perineal tear (rectal mucosa injury) during vaginal birth, and these tears are more common after forceps delivery (28%) and midline episiotomies. Third- and fourth-degree tears can become contaminated with bacteria from the rectum and this significantly increases in the chance of perineal wound infection. Prophylactic antibiotics might have a role in preventing this infection.

Objectives

To assess the effectiveness of antibiotic prophylaxis for reducing maternal morbidity and side effects in third- and fourth-degree perineal tear during vaginal birth.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2010) and the reference lists of retrieved articles.

Selection criteria

Randomised controlled trials comparing outcomes of prophylactic antibiotics versus placebo or no antibiotics in third- and fourth-degree perineal tear during vaginal birth.

Data collection and analysis

Two review authors independently assessed the reports and extracted data.

Main results

We identified and included one trial (147 participants) that compared the effect of prophylactic antibiotic (single-dose, second generation cephalosporin, intravenously) on postpartum perineal wound complications in third- or fourth-degree perineal tears. Perineal wound complications (wound disruption and purulent discharge) at the two-week postpartum check up were 8.20% and 24.10% in the treatment and the control groups respectively (risk ratio 0.34, 95% confidence interval 0.12 to 0.96).

Authors' conclusions

Although the data suggest that prophylactic antibiotics help to prevent perineal wound complications following third- or fourth-degree perineal tear, loss to follow-up was very high. The results should be interpreted with caution as they are based on one small trial.

Resumen

Antecedentes

Profilaxis antibiótica para el desgarro perineal de tercer y cuarto grado durante el parto vaginal

Del 1% al 8% de las mujeres sufre desgarros perineales de tercer grado (lesión del esfínter anal) y desgarros perineales de cuarto grado (lesión de la mucosa rectal) durante el parto vaginal, y estos desgarros son más frecuentes después del parto con fórceps (28%) y de las episiotomías de la línea media. Los desgarros de tercer y cuarto grado se pueden contaminar con bacterias del recto, lo que aumenta significativamente las probabilidades de infección de la herida perineal. Los antibióticos profilácticos pueden ser importantes para prevenir esta infección.

Objetivos

Evaluar la efectividad de la profilaxis antibiótica para reducir la morbilidad materna y los efectos secundarios en el desgarro perineal de tercer y cuarto grado durante el parto vaginal.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro Especializado de Ensayos Controlados del Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group) (31 agosto 2010) y en las listas de referencias de los artículos recuperados.

Criterios de selección

Ensayos controlados con asignación aleatoria que compararan los resultados de los antibióticos profilácticos versus placebo o ningún antibiótico en el desgarro perineal de tercer y cuarto grado durante el parto vaginal.

Obtención y análisis de los datos

Dos revisores evaluaron de forma independiente los informes y extrajeron los datos.

Resultados principales

Se identificó e incluyó un ensayo (147 participantes) que comparó el efecto del antibiótico profiláctico (en dosis única, cefalosporina de segunda generación, por vía intravenosa) en las complicaciones de la herida perineal posparto en los desgarros perineales de tercer y cuarto grado. Las complicaciones de las heridas perineales (apertura de la herida y secreción purulenta) hasta el chequeo posparto de dos semanas alcanzaron el 8,2% y el 24,1% en los grupos de tratamiento y control respectivamente (cociente de riesgos 0,34; intervalo de confianza [IC] del 95%: 0,12 a 0,96).

Conclusiones de los autores

Aunque los datos indican que los antibióticos profilácticos ayudan a prevenir las complicaciones de la herida perineal después del desgarro perineal de tercer y cuarto grado, las pérdidas durante el seguimiento fueron muy altas. Los resultados se deben interpretar con precaución, ya que sólo se basaron en un pequeño ensayo.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

Plain language summary

Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth

Most women are able to give birth without serious damage to their perineum. However, severe perineal trauma, which affects the muscle or tissue in the back passage, occurs in 1% to 8% of women giving birth and is common when forceps are used. There is an increased chance of infection when this happens, and antibiotics are often prescribed. The review of routine antibiotics for women with severe perineal tears identified one trial, involving 147 participants. This trial was conducted to explore the benefit of routine prophylactic antibiotics for women with severe perineal tears. The result showed fewer perineal wound complications when prescribing prophylactic antibiotic. However, the results are based on one small trial and there was a high loss to follow-up. More research is needed.