BJOG Journal Club
Timing antibiotic prophylaxis at caesarean: Preoperatively or after cord clamping?
You are charged with formulating a local clinical policy in your hospital about antibiotic prophylaxis at caesarean sections.
|Participants||Women undergoing emergency caesarean sections|
| ||Women undergoing elective caesarean sections|
|Intervention||A single dose of prophylactic antibiotic given preoperatively|
|Comparison||A single dose of prophylactic antibiotic given after cord clamping|
|Outcomes||Maternal: febrile morbidity, endometritis, wound infection and pyelonephritis|
| ||Neonatal: neonatal sepsis, neonatal septic work-up and neonatal intensive care unit (NICU) admission|
- Background: What do current guidelines say about the above question?
- What would be the best primary study design to study the above question and why?
- Sources of bias (what is the likelihood that the reported results are true?): Critically appraise, do not simply accept on face value, the methods of this systematic review and those of its constituent studies.
- What is sensitivity analysis? Is the use of sensitivity analysis in this study appropriate?
- Findings: Using the data available, derive the relative risk reduction (RRR), absolute risk reduction (ARR) and number needed to treat (NNT) of using preoperative prophylactic antibiotics on the overall maternal infectious morbidity.
- Applicability of findings: Do these results overturn the existing recommendations? Would you advocate the use of a) preoperative antibiotics and b) this particular antimicrobial (a cephalosporin) based on the results of this study?
Relative risk reduction (RRR): (CER − EER)/CER CER = control group event rate
Absolute risk reduction (ARR): (CER − EER) EER = experimental group event rate
Number needed to treat (NNT): 1/ARR or 1/(CER − EER)
- National Institute for Health and Clinical Excellence. CG132: Caesarean section Section 7.6. Available from: http://guidance.nice.org.uk/CG132/ Accessed 29 November 2012.
- The Society of Obstetricians and Gynaecologists of Canada (SOGC). Antibiotic Prophylaxis in Obstetric Procedures. (SOGC clinical practical guideline no. 247). The Society of Obstetricians and Gynaecologists of Canada (SOGC); September 2010. Access online: http://www.sogc.org/guidelines/documents/gui247CPG1009E_000.pdf
- American College of Obstetricians and Gynecologists (ACOG). Use of prophylactic antibiotics in labor and delivery. (ACOG practice bulletin; no. 120). Washington (DC): American College of Obstetricians and Gynecologists (ACOG). June 2011. Access online: http://www.guidelines.gov/content.aspx?id=34024
Disclosure of interests
EYL Leunga, D Siassakosb
aWomen's Health Research Unit, Katharine Twining Network, University of London, London, UK
bSchool of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, UK. Email firstname.lastname@example.org
For an example of how these discussion points were used for a recent #BlueJC, see BJOG Exchange in this issue. For more information see the commentary on page 657.