Antibiotic Prophylaxis for Operative Vaginal Delivery (Forceps and Vacuum Extraction)

A Cochrane review [Abstract] 1 included 2 studies with 3813 women undergoing forceps delivery or vacuum extraction. Superficial perineal wound infection (RR 0.53, 95% CI 0.40 to 0.69; n=3420) and deep perineal wound infection (RR 0.46, 95% CI 0.31 to 0.69; n=3420) were reduced. There was no difference in the length of hospital stay between the two groups (MD 0.09 days, 95% CI -0.23 to 0.41, n=393).

A multicentre RCT 2 in the UK (years 2016 to 2018, 3 427 women) assessed the effect of single dose of antibiotics intravenouly following operative vaginal birth (forceps and vacuum extraction). Within 6 weeks of delivery, significantly fewer women allocated to 1 g amoxicillin and 200mg clavulanic acid had a confirmed or suspected infection (180/1619, 11%) than women allocated to placebo (saline) (306/1606, 19%; RR 0.58, 95% CI 0.49 to 0.69; p<0.0001). One woman in the placebo group reported a skin rash and 2 women in the amoxicillin and clavulanic acid reported other allergic reactions, one of which was reported as a serious adverse event.

References

• Liabsuetrakul T, Choobun T, Peeyananjarassri K et al. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database Syst Rev 2020;(3):CD004455.[PubMed]
• Knight M, Chiocchia V, Partlett C et al. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial. Lancet 2019;393(10189):2395-2403. [PubMed]