Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial

OBJECTIVE: The purpose of this prospective study was to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity. STUDY DESIGN: In this double-blind placebo-controlled trial, cefazolin was given at skin incision (group A) or at cord clamping (group B). Patients were eligible for the trial if they had labored and required a cesarean delivery. RESULTS: Over a 30-month period 303 patients with singleton pregnancies entered the trial; 153-group A, 149-group B. Demographics, indication for cesarean delivery (P = .54), and operative time (P = .999), as well as rates of endometritis (RR 0.67, 95% CI 0.42-1.07), wound infection (RR 0.84, 95% CI 0.45-1.55), neonatal sepis (RR 1.28, 95% CI 0.91-1.79), and NICU admissions (RR 1.28, 95% CI 0.91-1.79) were similar between the 2 groups. CONCLUSION: There was no difference in maternal infectious morbidity whether antibiotics were given before skin incision or at cord clamping.