Should Prophylactic Antibiotics be Indicated for Operative Vaginal Delivery?

Prophylactic antibiotics can prevent infections after cesarean delivery, but whether antibiotics should be administered for operative vaginal delivery (i.e., forceps or vacuum) is not known. Investigators in the U.K. randomized 3427 women undergoing operative vaginal delivery at >36 weeks' gestation to receive a single intravenous dose of amoxicillin/clavulanic acid or placebo, administered a median of 3 hours after delivery. Endpoints included new prescription of antibiotics for documented systemic infection, endometritis, or perineal wound infection.

Rates of infection were 11% (antibiotic) versus 19% (placebo; P<0.0001). In the antibiotic group, significantly fewer women reported perineal pain, use of pain medication, perineal discomfort …