Dr. Almaira S. Pagayao, Dr. Josefa Dawn V. Martin
Southern Philippines Medical Center
Scientific Tracks Abstracts: Gynecol Obstet (Sunnyvale)
Background: Vaginal delivery is commonly associated with perineal lacerations that may increase infectious morbidity. Although prophylactic antibiotics reduce infection, unnecessary prolonged antibiotic use has associated risks. Single-dose antibiotic prophylaxis is recommended based on a single randomized controlled trial with low to moderate quality of evidence. Objective: To determine whether single-dose prophylaxis compared with a 7-day antibiotic regimen for high-order perineal lacerations will prevent wound complications. Methodology: This study was approved by the Ethics Review Committee. Prospective randomized controlled study design was used. 82 pregnant women were included. Group A received singledose Cefoxitin and Group B received 7-day regimen of Cefuroxime+/-Metronidazole. Pelvic exam was done at 24-48 hours, 1 week, and 2 weeks after delivery to monitor for wound complication. Results: Baseline profi les of both groups were comparable. At 24-48 hours postpartum, there was no signifi cant difference in wound complications between the two groups (0% vs 7%,p=0.058). Intention-to-treat analysis at 1 week postpartum showed signifi cantly more complications in Group B (0% vs 10%, P=0.020). At 2 weeks postpartum, none had wound complications in both groups. Birth weight >3kg, episiotomy, nulliparity and perineal length <3.5cm signifi cantly increased the risk of high-order perineal laceration. Birth weight >3kg signifi cantly increased the risk of wound complication (p=0.011). Conclusion: Single-dose Cefoxitin given at the time of repair of high-order perineal lacerations is more effective than 7-day regimen of Cefuroxime and Metronidazole in preventing wound complication at 1 week postpartum. No signifi cant difference on incidence of wound complication was noted between the treatment groups at 24-48 hours and 2 weeks postpartum. Keywords: antibiotic prophylaxis, dehiscence, episiotomy site infection, high order perineal laceration
Dr. Almaira Pagayao graduated from Cebu Institute of Medicine. She fi nished her training in Obstetrics and Gynecology in Southern Philippines Medical Center. She has presented her works in various regional, national, as well as international conferences.
Dr. Josefa Dawn Martin is a consultant in the Department of Obstetrics and Gynecology of the Southern Philippines Medical Center. She is an Infectious Disease Specialist, who fi nished her training in the University of the Philippines – Philippine General Hospital. She has been active in doing research, with multiple contributions to the Research Committee of the Department.