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Meta-Analysis
. 2014 Dec 5;2014(12):CD009516.
doi: 10.1002/14651858.CD009516.pub2.

Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery

A Dhanya Mackeen  1 , Roger E Packard, Erika Ota, Vincenzo Berghella, Jason K Baxter
Affiliations
Meta-Analysis

Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery

A Dhanya Mackeen et al. Cochrane Database Syst Rev. .

Abstract

Background: Given the continued rise in cesarean birth rate and the increased risk of surgical site infections after cesarean birth compared with vaginal birth, effective interventions must be established for prevention of surgical site infections. Prophylactic intravenous (IV) antibiotic administration 60 minutes prior to skin incision is recommended for abdominal gynecologic surgery; however, administration of prophylactic antibiotics has traditionally been withheld until after neonatal umbilical cord clamping during cesarean delivery due to the concern for potential transfer of antibiotics to the neonate.

Objectives: To compare the effects of cesarean antibiotic prophylaxis administered preoperatively versus after neonatal cord clamp on postoperative infectious complications for both the mother and the neonate.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2014) and reference lists of retrieved papers.

Selection criteria: Randomized controlled trials (RCTs) comparing maternal and neonatal outcomes following prophylactic antibiotics administered prior to skin incision versus after neonatal cord clamping during cesarean delivery. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCT and trials using a cross-over design were not eligible for inclusion in this review. Studies published in abstract form only were eligible for inclusion if sufficient information was available in the report.

Data collection and analysis: At least two review authors independently assessed the studies for inclusion, assessed risk of bias, abstracted data and checked entries for accuracy. We assessed the quality of evidence using the GRADE approach.

Main results: We included 10 studies (12 trial reports) from which 5041 women contributed data for the primary outcome. The overall risk of bias was low.When comparing prophylactic intravenous (IV) antibiotic administration in women undergoing cesarean delivery, there was a reduction in composite maternal infectious morbidity (risk ratio (RR) 0.57, 95% confidence interval (CI) 0.45 to 0.72, high quality evidence), which was specifically due to the reduction in endometritis (RR 0.54, 95% CI 0.36 to 0.79, high quality evidence) and wound infection (RR 0.59, 95% CI 0.44 to 0.81, high quality evidence) in those that received antibiotics preoperatively as compared to those who received antibiotics after neonatal cord clamping. There were no clear differences in neonatal sepsis (RR 0.76, 95% CI 0.51 to 1.13, moderate quality evidence).There were no clear differences for other maternal outcomes such as urinary tract infection (UTI), cystitis and pyelonephritis (moderate quality evidence), respiratory infection (low quality evidence), or any neonatal outcomes. Maternal side effects were not reported in the included studies.The quality of the evidence using GRADE was high for composite morbidity, endomyometritis, wound infection and neonatal intensive care unit admission, moderate for UTI/cystitis/pyelonephritis and neonatal sepsis, and low for maternal respiratory infection.

Authors' conclusions: Based on high quality evidence from studies whose overall risk of bias is low, intravenous prophylactic antibiotics for cesarean administered preoperatively significantly decreases the incidence of composite maternal postpartum infectious morbidity as compared with administration after cord clamp. There were no clear differences in adverse neonatal outcomes reported. Women undergoing cesarean delivery should receive antibiotic prophylaxis preoperatively to reduce maternal infectious morbidities. Further research may be needed to elucidate short- and long-term adverse effects for neonates.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias. graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Maternal postpartum infectious morbidity, outcome: 1.1 Composite morbidity (as defined by trials).
1.1
1.1. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 1 Composite morbidity (as defined by trials).
1.2
1.2. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 2 Endomyometritis.
1.3
1.3. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 3 Wound infection.
1.4
1.4. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 4 UTI/cystitis/pyelonephritis.
1.5
1.5. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 5 Pelvic abscess.
1.6
1.6. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 6 Respiratory infection (pneumonia).
1.7
1.7. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 7 Hospital length of stay (days).
1.8
1.8. Analysis
Comparison 1 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (maternal outcomes), Outcome 8 Febrile Illness.
2.1
2.1. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 1 Sepsis.
2.2
2.2. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 2 Neonatal sepsis work up.
2.3
2.3. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 3 Infection with a resistant organism.
2.4
2.4. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 4 Infection (other).
2.5
2.5. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 5 ICU admission.
2.6
2.6. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 6 ICU length of stay (days).
2.7
2.7. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 7 Neonatal antibiotic treatment.
2.8
2.8. Analysis
Comparison 2 Prophylactic intravenous antibiotics administered before cesarean incision versus after neonatal umbilical cord clamping (neonatal outcomes), Outcome 8 Fever.
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Update of

  • doi: 10.1002/14651858.CD009516

References

References to studies included in this review

Bhattacharjee 2013 {published data only}
    1. Bhattacharjee N, Saha SP, Patra KK, Mitra U, Ghoshroy SC. Optimal timing of prophylactic antibiotic for cesarean delivery: a randomized comparative study. Journal of Obstetrics and Gynaecology Research 2013;39(12):1560‐8. - PubMed
Francis 2013 {published data only}
    1. Francis C, Mumford M, Strand ML, Moore ES, Strand EA. Timing of prophylactic antibiotic at cesarean section: A double‐blinded, randomized trial. Journal of Perinatology 2013;33(10):759‐62. - PubMed
Kalaranjini 2013 {published data only}
    1. Kalaranjini S, Veena P, Rani R. Comparison of administration of single dose ceftriaxone for elective caesarean section before skin incision and after cord clamping in preventing post‐operative infectious morbidity. Archives of Gynecology and Obstetrics 2013;288(6):1263‐8. - PubMed
Kandil 2014 {published data only}
    1. Kandil M, Sanad Z, Gaber W. Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting. Journal of Maternal‐Fetal & Neonatal Medicine 2014;27(6):588‐91. - PubMed
Macones 2012 {published data only}
    1. Macones G, Cleary K, Odibo A, Gross G, Parry S, Rampersad R, et al. Timing of antibiotic prophylaxis at cesarean‐ results of an RCT. American Journal of Obstetrics and Gynecology 2008;199(6 Suppl 1):S33.
    1. Macones GA, Cleary KL, Parry S, Stamilio DM, Cahill AG, Odibo AO, et al. The timing of antibiotics at cesarean: A randomized controlled trial. American Journal of Perinatology 2012;29(4):273‐6. - PubMed
Sullivan 2007 {published data only}
    1. Sullivan S, Smith T, Chang E, Hulsey T, Dorsten J, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity. American Journal of Obstetrics and Gynecology 2006;195(6 Suppl 1):S17. - PubMed
    1. Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. American Journal of Obstetrics and Gynecology 2007;196(5):455.e1‐455.e5. - PubMed
Thigpen 2005 {published data only}
    1. Thigpen BD, Hood WA, Chauhan S, Bufkin L, Bofill J, Magann E, et al. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. American Journal of Obstetrics and Gynecology 2005;192:1864‐71. - PubMed
Wax 1997 {published data only}
    1. Wax JR, Hersey K, Philput C, Wright MS, Nichols KV, Eggleston MK, et al. Single dose cefazolin prophylaxis for postcesarean infections: before vs after cord clamping. Journal of Maternal Fetal Medicine 1997;6(1):61‐5. - PubMed
Witt 2011 {published data only}
    1. Witt A, Doner M, Petricevic L, Berger A, Germann P, Heinze G, et al. Antibiotic prophylaxis before surgery vs after cord clamping in elective cesarean delivery: a double‐blind, prospective, randomized, placebo‐controlled trial. Archives of Surgery 2011;146(12):1404‐9. - PubMed
Yildirim 2009 {published data only}
    1. Yildirim G, Gungorduk K, Guven HZ, Aslan H, Celikkol O, Sudolmus S, et al. When should we perform prophylactic antibiotics in elective cesarean cases?. Archives of Gynecology and Obstetrics 2009;280(1):13‐8. - PubMed

References to studies excluded from this review

Cunningham 1983 {published data only}
    1. Cunningham FG, Leveno KJ, Palma RT, Roark ML, Rosenfeld CR. Perioperative antimicrobials for cesarean delivery: before or after cord clamping?. Obstetrics & Gynecology 1983;62:151‐4. - PubMed
De Palma 1980 {published data only}
    1. Palma RT, Leveno KJ, Cunningham FG, Pope T, Kappus SS, Roark ML, et al. Identification and management of women at high risk for pelvic infection following cesarean section. Obstetrics & Gynecology 1980;55:185S‐192S. - PubMed
Gordon 1979 {published data only}
    1. Gordon HR, Phelps D, Blanchard K. Prophylactic cesarean section antibiotics: maternal and neonatal morbidity before or after cord clamping. Obstetrics & Gynecology 1979;53:151‐6. - PubMed
Gul 1999 {published data only}
    1. Gul A, Zeteroilu I, Surucu R. The comparison of piperacillin use for prophylaxis of post cesarean section infection before and after clamping umbilical cord [abstract]. Infectious Diseases in Obstetrics & Gynecology 1999;7(6):306.
Nokiani 2009 {published data only}
    1. Nokiani FA, Akbari H, Rezaei M. Timing of prophylactic antibiotic administration in term cesarean section: a randomized clinical trial. Iranian Journal of Clinical Infectious Diseases 2009;4(2):71‐6.
Rodriguez 1990 {published data only}
    1. Rodriguez GC, Gall SA, Parsons MT. Timing of prophylactic antibiotic administration at cesarean section. Proceedings of 10th Annual Meeting of Society of Perinatal Obstetricians; 1990 Jan 23‐27; Houston, Texas, USA. 1990:311.
Seton 1996 {published data only (unpublished sought but not used)}
    1. Seton DN, Vellema DMM, Schoon MG, Grobler JM. Prophylactic antibiotics and caesarean section: comparing ceftriaxone administration pre‐ and post‐ umbilical cord clamping in terms of maternal and neonatal morbidity. 15th Conference on Priorities in Perinatal Care in Southern Africa; 1996 March 5‐8; Goudini Spa, South Africa. 1996.
Tassi 1987 {published data only}
    1. Tassi PG, Tarantini M, Cadenelli GP, Gastaldi A, Benedetti M. Ceftazidime in antibiotic prophylaxis for emergency cesarean section: a randomized prospective study. International Journal of Clinical Pharmacology, Therapeutics and Toxicology 1987;25:582‐8. - PubMed
van Beekhuizen 2008 {published data only}
    1. Beekhuizen H. Prevention of post‐caesarean infections in low resource countries: is a single dose as adequate as a multiple dose antibiotic regiment? A randomised controlled trial. Current Controlled Trials (www.controlled‐trials.com/) [accessed 20 February 2008] 2008.
Van Velzen 2009 {published data only}
    1. Velzen C, Kolk P, Westen E, Mmuni N, Hamisi A, Nakua R, et al. Comparison of a single prophylactic dose of ampicillin and metronidazole before caesarean section with a multiple day regimen of these antibiotics in prevention of postpartum maternal infection in a low resource setting: a randomized controlled trial. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S369.
Xu 1997 {published data only}
    1. Xu X, Zhang W, He X. Use of cefotaxime to control post‐operative infection in patients who underwent C‐section. Acta Academiae Medicinae Hubei 1997;18:74‐6.

References to studies awaiting assessment

Pevzner 2009 {published data only (unpublished sought but not used)}
    1. Pevzner L, Chan K. Optimal timing for antibiotic prophylaxis during elective cesarean: before or after cord clamping. American Journal of Obstetrics and Gynecology 2009;201(6 Suppl 1):S225‐S226.

References to ongoing studies

Zhang 2012 {published data only}
    1. Zhang L. Timing of perioperative antibiotics for cesarean: a multicenter randomized controlled study. Chinese Clinical Trial Register [accessed 31 May 2013] 2012.

Additional references

ACOG 2010
    1. American College of Obstetricians and Gynecologists. Antimicrobial prophylaxis for cesarean delivery: timing of administration. Committee Opinion No. 465. Obstetrics & Gynecology 2010;116:791‐2. - PubMed
Baaqeel 2013
    1. Baaqeel H, Baaqeel R. Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta‐analysis. BJOG: an international journal of obstetrics and gynaecology 2013;120(6):661‐9. [DOI: 10.1111/1471-0528.12036] - DOI - PMC - PubMed
Barwolff 2006
    1. Barwolff S, Sohr D, Feffers C, Brandt C, Vonberg RP, Halle H, et al. Reduction of surgical site infections after Cesarean delivery using surveillance. Journal of Hospital Infections 2006;64(2):156‐61. - PubMed
Baxter 2011
    1. Baxter JK, Berghella V, Mackeen AD, Ohly NT, Weed S. Timing of prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database of Systematic Reviews 2011, Issue 12. [DOI: 10.1002/14651858.CD009516] - DOI - PMC - PubMed
Bloom 1996
    1. Bloom SL, Cox SM, Bawdon RE, Gilstrap LC. Ampicillin for neonatal group B streptococcal prophylaxis: how rapidly can bactericidal concentrations be achieved?. American Journal of Obstetrics and Gynecology 1996;175(4 Pt 1):974‐6. - PubMed
Bratzler 2005
    1. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. American Journal of Surgery 2005;189(4):395‐404. - PubMed
Burke 1961
    1. Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 1961;50:161‐8. - PubMed
Classen 1992
    1. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical‐wound infection. New England Journal of Medicine 1992;326(5):281‐6. - PubMed
Costantine 2008
    1. Costantine MM, Rahman M, Ghulmiyah L, Byers BD, Longo M, Wen T, et al. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. American Journal of Obstetrics and Gynecology 2008;199(3):301.e1‐301.e6. - PubMed
Dahlke 2013
    1. Dahlke J, Mendez‐Figueroa H, Rouse D, Berghella V, Baxter J, Chauhan, S. Evidence‐based surgery for cesarean delivery: an updated systematic review. American Journal of Obstetrics and Gynecology 2013;209(4):294‐306. - PubMed
Edi‐Osagie 1998
    1. Edi‐Osagie EC, Hopkins RE, Ogbo V, Lockhat‐Cleff F, Ayeko M, Akpala WO, et al. Uterine exteriorization at cesarean section: influence on maternal morbidity. British Journal of Obstetrics and Gynaecology 1998;105(10):1070‐8. - PubMed
Fiore 2001
    1. Fiore Mitchell T, Pearlman MD, Chapman RL, Bhatt‐Mehta V, Faiz RG. Maternal and transplacental pharmacokinetics of cefazolin. Obstetrics & Gynecology 2001;98(6):1075‐9. - PubMed
Gibbons 2012
    1. Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. American Journal of Obstetrics and Gynecology 2012;206(4):311‐e1. - PubMed
GRADE 2008 [Computer program]
    1. Jan Brozek, Andrew Oxman, Holger Schünemann. GRADEpro. Version 3.6 for Windows., 2008.
Hellums 2007
    1. Hellums EK, Lin MG, Ramsey PS. Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery‐‐a metaanalysis. American Journal of Obstetrics and Gynecology 2007;197(3):229‐35. - PubMed
Henderson 1995
    1. Henderson E, Love EJ. Incidence of hospital‐acquired infections associated with cesarean section. Journal of Hospital Infection 1995;29:245‐55. - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated September 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hopkins 1999
    1. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database of Systematic Reviews 1999, Issue 2. [DOI: 10.1002/14651858.CD001136] - DOI - PubMed
Kaimal 2008
    1. Kaimal AJ, Zlatnik MG, Cheng YW, Thiet MP, Connatty E, Creedy P, et al. Effect of a change in policy regarding the timing of prophylactic antibiotics on the rate of postcesarean delivery surgical‐site infections. American Journal of Obstetrics and Gynecology 2008;199(3):310.e1‐310.e5. - PubMed
Leth 2009
    1. Leth RA, Moller JK, Thomsen RW, Uldbierg N, Norgaard M. Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five‐year cohort study of 32,468 women. Acta Obstetricia et Gynecologica Scandinavica 2009 Jul 29:[Epub ahead of print]. - PubMed
Lorenz 1988
    1. Lorenz RP, Botti JJ, Appelbaum PC, Bennett N. Skin preparation methods before cesarean section. A comparative study. Journal of Reproductive Medicine 1988;33(2):202‐4. - PubMed
Magann 1993
    1. Magann EF, Dodson MK, Ray MA, Harris RL, Martin JN Jr, Morrison JC. Preoperative skin preparation and intraoperative pelvic irrigation: impact on post‐cesarean endometritis and wound infection. Obstetrics & Gynecology 1993;81(6):922‐5. - PubMed
Mangram 1999
    1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999: Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. American Journal of Infection Control 1999;27:97‐132. - PubMed
NNIS System 2004
    1. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. American Journal of Infection Control 2004;32(8):470‐85. - PubMed
Olsen 2008
    1. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infection Control and Hospital Epidemiology 2008;29(6):477‐84. - PubMed
Opoien 2007
    1. Opoien HK, Valbo A, Grinde‐Andersen A, Walberg M. Post‐cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstetricia et Gynecologica Scandinavica 2007;86(9):1097‐102. - PubMed
Owens 2009
    1. Owens SM, Brozanski BS, Mevn LA, Wiesenfeld HC. Antimicrobial prophylaxis for cesarean delivery before skin incision. Obstetrics & Gynecology 2009;114(3):573‐9. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Schunemann 2009
    1. Schunemann HJ. GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice [GRADE: Von der Evidenz zur Empfehlung. Beschreibung des Systems und Losungsbeitrag zur Ubertragbarkeit von Studienergebnissen]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 2009;103(6):391‐400. [PUBMED: 19839216] - PubMed
Sievert 2013
    1. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, et al. Antimicrobial‐resistant pathogens associated with healthcare‐associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009‐2010. Infection Control and Hospital Epidemiology : the official journal of the Society of Hospital Epidemiologists of America 2013;34(1):1‐14. [PUBMED: 23221186] - PubMed
Smaill 2010
    1. Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007482.pub2] - DOI - PMC - PubMed
Soar 2009
    1. Soar J, Peyton J, Leonard M, Pullyblank AM. Surgical safety checklists. BMJ 2009;338:b220. - PubMed
Souza 2013
    1. Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross‐sectional study. Lancet 2013;381(9879):1747‐55. - PubMed
Starr 2005
    1. Starr RB, Zurawski J, Ismail M. Preoperative vaginal preparation with povidone‐iodine and the risk of postcesarean endometritis. Obstetrics & Gynecology 2005;105(5 Pt 1):1024‐6. - PubMed
Ventolini 2004
    1. Ventolini G, Neiger R, McKenna D. Decreasing infectious morbidity in cesarean delivery by changing gloves. Journal of Reproductive Medicine 2004;49(1):13‐6. - PubMed
Wloch 2012
    1. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG: An International Journal of Obstetrics & Gynaecology 2012;119(11):1324‐33. [DOI: 10.1111/j.1471-0528.2012.03452.x] - DOI - PubMed
Yokoe 2001
    1. Yokoe DS, Christiansen CL, Johnson R, Sands KE, Livingston J, Shtatland ES, et al. Epidemiology of and surveillance for postpartum infections. Emerging Infectious Diseases 2001;7:837‐41. - PMC - PubMed

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