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New recommendation for College statement Instrumental vaginal birth (C-Obs 16)

21 April 2020

In light of new findings from the Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE) trial, a new recommendation was included in the College statement Instrumental vaginal birth (C-Obs 16), ratified during March Council and Board meetings.

The new recommendation states that ‘For women who undergo assisted vaginal birth, consideration should be given to prophylactic antibiotics to reduce the risk of post-partum infection.’

In the ANODE trial, the administration of intravenous Augmentin within 6 hours of delivery was associated with a reduction in the primary outcome - suspected or confirmed maternal infection within 6 weeks of delivery. Significantly fewer women allocated to amoxicillin and clavulanic acid had a confirmed or suspected infection (180 [11%] of 1619) than women allocated to placebo (306 [19%] of 1606; risk ratio 0·58, 95% CI 0·49-0·69; p<0·0001).  Infection was defined by a new prescription of antibiotics for specific indications, confirmed systemic infection on culture, or endometritis. This study provides evidence for administering antibiotics to women following operative vaginal delivery.1

The recommended regime is Amoxicillin-Clavulanate iv 1000mg+200mg. For women without iv access, oral antibiotics (Amoxicillin-Clavulanate 875/125 oral tablet) may be given. For women allergic to Penicillin, Cephazolin 2g IV or Clindamycin 600mg IV are suggested alternatives.

The full article can be accessed via the following link:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30773-1/fulltext
 
  1. Knight M, Chiocchia V, Partlett C, Rivero-Arias O, Hua X, Hinshaw K, et al. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial, Lancet. 2019;393(10189):2395-403.



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