Antibiotic prophylaxis in cesarean section.

Several controversies exist regarding the use of antibiotic prophylaxis in cesarean section. Studies have investigated effectiveness, choice of drug, timing, duration, and appropriate route of administration. Efficacy of antibiotic prophylaxis in preventing postoperative endometritis in certain high-risk patients has been well documented. Factors identifying patients at high risk for endometritis include: indigent socioeconomic status, labor prior to cesarean section, rupture of chorioamniotic membranes, and number of vaginal examinations. Although many different antibiotics have been tested, no particular regimen has been found to be superior. Administration of antibiotics after cord clamping reduces the risk of fetal exposure without compromising maternal risk of endometritis. A single dose of ampicillin or a first-generation cephalosporin (e.g., cefazolin or cephalothin sodium) given intravenously provides adequate prophylaxis. No additional benefit has been demonstrated with the use of multiple-dose regimens.