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Should prophylactic antibiotics be routinely given to a mother before a cesarean birth?

infections, and urinary tract infections (National Guideline Clearinghouse, 2013). Prior to the new recommendation from the ACO, antibiotics were withheld until after cord clamping because of the concern that antibiotics transferred to the fetus would mask signs of infection, and fetal exposure to antibiotics may lead to increased newborn colonization with antibiotic-resistant organisms. However, studies of newborns have not shown any deleterious effect. Treatment prior to cord clamping may mean that newborns may have to undergo a more complex workup because blood cultures may not be accurate. However, a thorough pediatric assessment is sufficient to assure proper treatment of a newborn. In a study of 8,668 women undergoing cesarean at Washington University School of Medicine, administering antibiotics prior to cord clamping decreased the infection rate by 50%. A multivariate analysis studying five different variables found that only prophylactic antibiotics significantly decreased the rate of infection (Kittur et al., 2012). The failure to treat a woman undergoing a cesarean with antibiotics prior to birth, unless there is an emergency, where a dose would be given as soon as possible, is a departure from acceptable medical standards. This could lead to complications including endometritis, wound infection, pelvic thrombophlebitis, sepsis, and subsequent sequelae. The antibiotic often chosen is a single dose of narrow spectrum antibiotic such as Clindamycin 900 mg intravenous plus gentamicin 1.5 mg/kg intravenous if the patient is beta-lactam allergic. Although there are many obstetric practices that vary among providers, the decision to administer prophylactic antibiotics to women undergoing cesarean birth prior to clamping of the umbilical cord is the standard of care. Implementation of such a policy will decrease the overall rate of cesarean-related infections without adverse outcomes to mothers and their newborns.