A report from #BlueJC: Prophylactic antibiotics for caesarean section—before or after cord-clamping?
Article first published online: 9 APR 2013
© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 6, pages 779–780, May 2013
How to Cite
(2013), A report from #BlueJC: Prophylactic antibiotics for caesarean section—before or after cord-clamping?. BJOG: An International Journal of Obstetrics & Gynaecology, 120: 779–780. doi: 10.1111/1471-0528.12244
- Issue published online: 9 APR 2013
- Article first published online: 9 APR 2013
Paper discussed: Baaqeel H, Baaqeel R. Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis. BJOG 2013;120:661–9.
Date of journal club: 13 December 2012
Number of participants: 13 (including author)
Number of Tweets: ~100 (73 storified)
|Participants||Women undergoing any type of caesarean section|
|Intervention||A single dose of prophylactic antibiotic given preoperatively|
|Comparison||A single dose of prophylactic antibiotic given intraoperatively|
Maternal: febrile morbidity, endometritis, wound infection and pyelonephritis
Neonatal: neonatal sepsis, neonatal septic work-up and neonatal intensive-care unit (NICU) admission
|Study design||Systematic review with meta-analysis of randomised trials|
Research Literacy: Systematic review, meta-analysis and publication bias
In this systematic review, data from randomised trials were meta-analysed (statistically combined to produce summary relative-risk estimates). Meta-analytic techniques also exist for diagnostic data to statistically summarise sensitivity and specificity of tests. Qualitative data synthesis, sometimes called meta-synthesis, can be used to summarise patient experiences without the need to employ statistics. The quality of a systematic review depends in part on the comprehensiveness of the literature search. The risk of missing studies can be assessed using funnel plot.
Feedback on the study
Why did this paper only include trials of single agent antibiotics?
Professor Baaqeel (author) suggested that the use of a single-agent regimen was prevailing practice and a Cochrane review (Hopkins et al. Cochrane Database Syst Rev. 2000;(2):CD001136) confirmed its efficacy.
What about neonatal safety?
This paper highlighted the uncertainty of evidence on the safety of preoperative antibiotics for babies. One reason for use of antibiotics after cord-clamping is the avoidance of adverse effects on babies. Among the neonatal outcomes reviewed, potential long-term effects, for example the risks of allergy or atopy, were not evaluated in this paper. With reference to another recent paper (Teune et al. BJOG 2013;120:15–22) the importance of long-term follow-up was recognised.
A shift from using co-amoxiclav was noted in view of the recent recommendation by the National Institute of Clinical Excellence (NICE, Clinical guidance 132, 2011; http://guidance.nice.org.uk/CG132). Practice in the UK deployed a combination of cephalosporins and metronidazole. Belgium, Saudi Arabia and Argentina routinely used a single-agent cephalosporin.
Take home message
Prophylactic antibiotics for caesarean section reduce maternal infectious morbidity. #BlueJC highlighted variations in practice between different regions and countries and the need for acquiring information on long-term follow-up of children.
Disclosure of interests
EYL is a BJOG Associate responsible for coordinating journal clubs.
Contribution to authorship
EYL planned this journal club, collected all relevant Tweets and summarised them.
We are grateful for all contributions to this journal club. For the Storify summary and the full list of contributors, please go to http://storify.com/kt_network/ktjc-pilot-3-the-timing-of-prophylactic-antibioti. The development of this journal club was made possible with the help of Dr Seema Anushka Tirlapur of the Katherine Twining Network (http://ktnetwork.org/).
Women's Health Research Unit, Katherine Twinning Network,
Queen Mary, University of London, London, UK
About #BlueJC: For a background and introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Further infomation is available on www.BJOG.org.