May 13, 2019

expert reaction to study on preventative antibiotics after assisted childbirth

Research published in The Lancet shows benefit of a single dose of prophylactic antibiotic after operative vaginal birth.

Dr Dimitrios Siassakos, Associate Professor and Reader in Obstetrics, University College London (UCL), said:

“This paper presents the findings of a large study with potentially significant repercussions. Should all women who have an assisted childbirth (forceps or ventouse) receive prophylactic antibiotics to reduce their risk of infection from now on?

 “The study results show that giving antibiotics within 6 hours after birth reduces the need for antibiotics later, and 17% overall, at the expense of one serious allergic reaction out of more than 1,000 women. 

 “Is this difference in antibiotic need good enough to make us give antibiotics to all women from tomorrow, considering that it might increase resistance to antibiotics?

“Women who received antibiotics for prevention were half as likely, compared to those who did not, to report a breakdown of their perineal wound, but without difference in their likelihood to report painful sexual intercourse. They were less likely to report it was painful to feed the baby but not more likely to breastfeed. What might be key, before any decision is made to introduce routine antibiotic use to clinical practice, guidelines, and training for assisted childbirth, is to investigate what these differences mean to women, especially in the long term. It is also important to investigate whether earlier administration of the antibiotics, before as opposed to after birth, will have a greater effect on the risk of infection, balancing the risks of resistance to antibiotics.”

Dr Pat O’Brien, Consultant Obstetrician and Spokesperson for the Royal College of Obstetricians and Gynaecologists:

“This is a very interesting and well-conducted trial. Around 12% of women in the UK have an assisted birth and these result show that single dose antibiotic use could reduce infections by half – equivalent to around 7,000 infections every year.

“It is standard practice to provide single dose antibiotic to all women who have a caesarean birth to reduce infection, and it follows that this should be considered for women following an assisted birth.

“Based on these findings alone, it does seem that routine use of a single dose of antibiotic following an assisted birth would help to reduce infections and ensure the best possible health outcomes for women, as well as reduce costs of complications for the health service.” 

‘Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial’ by Marian Knight et al. was published in Lancet at 23:30 UK time on Monday 13th May.

Declared interests

Dr Dimities Siassakos: Dr Siassakos is national convenor for ROBUST national operative birth courses, which he also co-developed however this comment in in his capacity as an individual expert and not representing RCOG or ROBUST.

None others received.