Some women scheduled for cesarean delivery have concurrent comorbidity that requires specific management in anticipation of surgery. Among others, these include insulin-requiring or gestational diabetes, coagulopathy or thrombophilia, chronic corticosteroid use, and signiicant reactive airway disease. Surgical preparations are discussed in the respective chapters covering these topics.
Cesarean delivery is considered a clean contaminated case, and postoperative febrile morbidity is common. Numerous goodquality trials show that a single dose of an antibiotic given at the time of cesarean delivery signiicantly decreases infectious morbidity (Smaill, 2014). Although more obvious for women undergoing unscheduled cesarean delivery, this practice also pertains to women undergoing elective surgery (American College of Obstetricians and Gynecologists, 2016). Depending on drug allergies, most recommend a single intravenous dose of a 3-lactam antibiotic-either a cephalosporin or extended-spectrum penicillin. A 1-g dose of cefazolin (Ancd) is an eicacious and cost-efective choice. Additional doses are considered in cases with blood loss > 1500 mL or with duration longer than 3 hours. Recommen dations for the best dose in obese parturients are conflicting (Ahmadzia, 2015; Maggio, 2015; Swank, 2015; Young, 2015).
levels with a 2-g dose for cesarean deliveries lasting 1.5 hours.
women if surgeries were longer (Grupper, 2017).
A growing body of evidence supports extending the antibiotic spectrum (Andrews, 2003; Tita, 2008). One large randomized trial added azithromycin, 500 mg intravenously, to standard prophylaxis prior to cesarean delivery for women in labor or with ruptured membranes (Tita, 2016). Rates of wound infection and endometritis were signiicantly lower in the extended-spectrum group compared with those in the standard prophylaxis cohort.
In pregnant women with a history of infection with methicillin-resistant Staphylococcus aureus (MRSA), a single dose of vancomycin added to the standard prophylaxis for cesarean deliveries can be elected. Decolonization plays a limited role but may be considered prior to a planned cesarean delivery in women with known MRSA colonization (American College of Obstetricians and Gynecologists, 2016).
Significant penicillin or cephalosporin allergy, which manifests by anaphylaxis, angioedema, respiratory distress, or urticaria, merits prophylaxis with a single 600-mg intravenous dose of clindamycin combined with a weight-based dose of an aminoglycoside as an alternative. A 900-mg clindamycin dose is used for obese patients.
Antibiotic administration before surgical incision lowers postoperative infection rates without adverse neonatal efects compared with drug administration after umbilical cord clamping (Mackeen, 2014b; Sullivan, 2007; Witt, 2011). Prophylaxis is ideally administered within the 60 minutes prior to the start of planned cesarean delivery. For emergent delivery, antibiotics are given as soon as feasible.