Prophylactic Administration of Cefazolin Prior to Skin Incision versus Antibiotics at Cord Clamping in Preventing Postcesarean Infectious Morbidity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Aim: To summarize the published evidence of prophylactic cefazolin for cesarean delivery given before the procedure versus at cord clamping. Methods: We systematically searched the databases of PubMed, Embase, and CENTRAL in the Cochrane Library for randomized controlled trials that compared prophylactic antibiotics with cefazolin for cesarean delivery given before the procedure versus at cord clamping. Results: Six randomized controlled trials with high quality were included in this meta-analysis. Preoperative administration significantly reduced the risk of postpartum endometritis (RR: 0.57, 95% CI: 0.36-0.90, p = 0.02). Preoperative administration of cefazolin was not associated with a significant reduction in the risk of wound infection (RR: 0.70, 95% CI: 0.43-1.12) and urinary tract infection (RR: 1.19, 95% CI: 0.53-2.63). Furthermore, preoperative administration of cefazolin did not significantly affect proven neonatal sepsis (RR: 0.82, 95% CI: 0.47-1.42), suspected neonatal sepsis that requires a workup (RR: 0.94, 95% CI: 0.72-1.22), or neonatal intensive care unit admissions (RR: 0.90, 95% CI: 0.62-1.28). Conclusion: Pooled results demonstrated that antibiotic prophylaxis with cefazolin for cesarean delivery that is given before skin incision can significantly decrease the incidence of postpartum endometritis.