Prophylactic antibiotics for cesarean delivery: a simple cost-effective strategy for prevention of postoperative morbidity.

Postoperative endomyometritis is the most common complication associated with cesarean delivery. The frequency of endomyometritis varies from 5% to 85% (mean 35% to 40%), depending on the socioeconomic characteristics of the patient population and the indication for abdominal delivery. In women undergoing cesarean section after extended duration of labor and ruptured membranes, the use of prophylactic antibiotics has been consistently effective in decreasing the frequency of endomyometritis. A single dose of antibiotic administered after the umbilical cord is clamped provides a degree of prophylaxis comparable to that achieved with two- and three-dose regimens. There is no evidence that the newer extended-spectrum cephalosporins or penicillins are better for prophylaxis than ampicillin or a first-generation cephalosporin. Administration of antibiotics by intraoperative irrigation is an acceptable, but not superior, alternative to systemic antibiotic administration. Prophylactic antibiotics alter the vaginal flora after operation, but to date harmful clinical effects have not occurred as a result of such alteration.