Authors: Martha Powell, Future Science Group
Giving a single dose of preventative antibiotics after assisted childbirth could prevent almost half of maternal infections, according to the results of a large, randomized trial – the ANODE study.
Currently infection rates after assisted vaginal births, involving forceps of vacuum extraction, are at approximately 16% worldwide, totalling 7000 maternal infections in the UK every year and 5000 in the USA. Leader of this study, Marian Knight from the University of Oxford (UK), commented: “Pregnancy-associated infection is a major cause of death and serious illness. Almost one in five women develop an infection after assisted vaginal delivery and our results show that this could be reduced by almost half by a single dose of prophylactic antibiotic.”
This was the first randomized trial of its kind, published in the Lancet it involved 3420 women across the UK from 27 obstetric units. Between March 2016 and June 2018 the women were randomly assigned to receive either intravenous amoxicillin and clavulanic acid (1715 women) or a placebo (1705 women) within 6 hours of vaginal delivery.
Suspected or confirmed maternal infection was then monitored by the team via prescription for antibiotics, confirmed systemic infection on culture or endometritis within 6 weeks of birth.
The researchers discovered that women who received a single dose of antibiotics after assisted childbirth had significantly fewer suspected or confirmed infections than women given placebo (180/1619; 11% vs 306/1606; 19%). In addition, women receiving antibiotic prophylaxis were also much less likely to have confirmed culture-proven sepsis compared to those receiving placebo (a 56% reduction at 0.6% vs 1.5%).
The results also reported that for every additional 100 doses of antibiotic given prophylactically, 168 doses could be avoided due to fewer postdelivery infections, meaning that this strategy could help reduce antibiotic use by 17%.
Despite several limitations, including that presumed rather than culture-proven infection was the primary outcome and that only three-quarters of women were followed up for secondary outcomes, this intervention could be used to prevent maternal infections globally. The team suggest that research into the most effective timing of antibiotic administration could be necessary – for example, whether earlier administration or repeated administration could be more effective.
Knight concluded: “These findings highlight the urgent need to change current WHO antibiotic guidelines and other guidance from organizations in the UK, North America and Australasia, that do not recommend routine antibiotic prophylaxis for assisted childbirth.”
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Source: Knight M, Chiocchia V, Partlett C et al. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial. Lancet doi:10.1016/S0140-6736(19)30773-1 (2019): www.eurekalert.org/emb_releases/2019-05/tl-pss051019.php