Recommendations and evidence synthesis: guidelines on antibiotic prophylaxis and choice of antiseptics for women in instrumental vaginal delivery or cesarean section

Abstract

Introduction. Maternal sepsis and infections during or after childbirth increase maternal mortality, leading to a high burden of disease in the Region of the Americas. The risk of infection after a cesarean section or instrumental vaginal delivery can be reduced with the appropriate skin antiseptic agents and antibiotic prophylaxis. Objectives. To synthesize World Health Organization (WHO) recommendations to improve the quality of care and health outcomes related to routine antibiotic prophylaxis in women during instrumental vaginal delivery; routine use of antibiotic prophylaxis in women having a cesarean section; the choice of antiseptics and skin preparation methods before a cesarean; and vaginal irrigation with antiseptics in women undergoing a cesarean. Methods. The WHO guidelines were based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology as described in the WHO Handbook for Guideline Development. Recommendations contained in four WHO guidelines were synthesized and a systematic search for studies carried out in the Region of the Americas was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature to identify barriers, facilitators, and implementation strategies. Results. Five recommendations were made on the routine use of antibiotic prophylaxis in women undergoing instrumental vaginal delivery, routine use of antibiotic prophylaxis in women having a cesarean section, the choice of antiseptics and skin preparation prior to a cesarean section, and vaginal irrigation with antiseptics during a cesarean section. Implementation barriers and facilitators were identified, and indicators were created to assess adherence and outcomes. Conclusions. The formulated recommendations aim to provide guidance on how to improve quality of care and outcomes related to antibiotic prophylaxis and the choice of antiseptics in women undergoing instrumental vaginal delivery or a cesarean section.