Use of prophylactic antibiotics in obstetrics

The article is written by Master, Doctor Nguyen Nhu Thu Truc - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Nha Trang International General Hospital.

The use of prophylactic antibiotics in obstetrics aims to prevent infection during obstetric and gynecological interventions. The use of prophylactic antibiotics is of high value in preventing infection in women with cesarean section in order to reduce the rate of surgical site infection and the duration of antibiotic use.

Antibiotic prophylaxis is the use of antibiotics before an infection occurs for the purpose of preventing surgical site infection. Therefore, the selected prophylactic antibiotic must set the bactericidal concentration in the tissue at the time of most infection.
Prophylactic antibiotics can reduce the frequency of infections that occur after some surgeries but are not able to completely kill bacteria.
Caesarean section is the most common major surgery performed. The risk of complications such as surgical site infection and endometritis is 5 to 10 times greater than vaginal delivery. The use of prophylactic antibiotics before cesarean section is recommended to reduce this risk, reduce the burden of disease on the mother, and reduce the cost of medical care.
How to use prophylactic antibiotics include:
Antibiotics need to be used within 60 minutes before surgery because antibiotics must be present in a place where there is a risk of infection right after surgical intervention Do not use prophylactic antibiotics postoperatively because prolonged prophylactic antibiotics after surgery is often futile. Selective antibiotics to target pathogenic bacteria Can't rely solely on prophylactic antibiotics and neglect infection control measures

Surgery is divided into 4 types: clean, clean-contaminated, contaminated, dirty. Prophylactic antibiotics are used when there is no infection, so only for clean or clean-contaminated surgery. Cases of suspected or confirmed infection requiring antibiotic treatment (amniotic infection, adnexal abscess, peritonitis,...)
Specific indications include:
Acute cesarean section rescue or be proactive. Research has shown that prophylactic antibiotics are usually given within 60 minutes before cesarean section incision. To achieve antibiotic concentration at the incision site before skin incision, it is necessary to inject prophylactic antibiotics 30 minutes before. Prophylaxis of infective endocarditis during obstetric procedures and surgery Manual removal of the placenta, restoration of third and fourth degree perineal tears, suture of the isthmus, dilation and curettage, postpartum hysterectomy, transvaginal hysterectomy, trans-abdominal or laparoscopic surgery Laparoscopic surgery for diagnostic purposes, biopsies, ovarian ligation Pelvic floor-urinary surgery Obstetric abortion.

Use prophylactic antibiotics for surgery for which clinical trials have shown that prophylactic antibiotics reduce surgical site infections
Prophylactic antibiotics are safe, inexpensive, and bactericidal for most bacteria Timing of the first dose of antibiotic so that bactericidal concentrations are achieved in serum and tissues before skin incision Maintain antibiotic concentrations in serum and tissues throughout surgery, and some hours after suturing Ensure that the benefits outweigh the harmful effects of prophylactic antibiotics Few or no adverse reactions, as little toxicity as possible. Antibiotics do not interact with drugs used for anesthetics The ability of the antibiotic to diffuse in the tissue must allow drug concentrations higher than the minimum antibacterial concentration of the infecting organism. Use prophylactic antibiotics properly according to the prophylactic antibiotic regimen set by the Ministry of Health to prevent the risk of infection during surgery, helping to protect the patient's health in the most optimal way. .