A single dose of preventative antibiotics after forceps or vacuum delivery could prevent almost half of maternal infections, equivalent to over 7000 maternal infections every year in the UK.
That is the conclusion of the first randomised trial of its kind in the UK involving 3420 women from 27 obstetric units. The findings, published in the Lancet, also found that for every additional 100 doses of antibiotic given prophylactically, 168 doses could be avoided due to fewer post-delivery infections, meaning that a policy of universal prophylaxis after birth could help to reduce antibiotic use by 17 per cent.
Between March 2016 and June 2018, women were randomly assigned to receive intravenous amoxicillin and clavulanic acid (n=1715) or placebo (n=1705) within 6 hours of operative vaginal delivery.
Of the final cohort, 437 (13%) women had ruptured membranes for more than 24 hours before giving birth. A total of 2234 (65%) births were by forceps and 1196 (35%) were by vacuum extraction. The majority of women (89%) had an episiotomy.
Significantly fewer women allocated to amoxicillin and clavulanic acid had a confirmed or suspected infection than women allocated to placebo (11% vs 19%; risk ratio [RR], 0.58; 95% CI, 0.49-0.69; P<.0001).
Rates of perineal wound infection or breakdown (burst stiches), perineal pain, use of pain relief for perineal pain, and need for additional perineal care were also substantially lower in the group who received antibiotics compared to the placebo group. Additionally, women who received antibiotics were much less likely to report any GP, nurse, or midwife home visits, or hospital outpatient visits due to wound healing compared to the placebo group.
Based on the figures, the study authors estimate that a single dose of antibiotic could save the NHS £52.60 per women during the first six weeks after delivery.
