Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation.

IF 4.3 4区 医学 Q1 OBSTETRICS & GYNECOLOGY
Katherine A Lambert, Anne West Honart, Brenna L Hughes, Jeffrey A Kuller, Sarah K Dotters-Katz
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引用次数: 0

Abstract

Importance: Multiple postpartum scenarios require uterine exploration or instrumentation. These may introduce bacteria into the uterus, increasing the risk of endometritis. Data on the use of antibiotics in these scenarios is limited, resulting in few guidelines and divergent care.

Objective: To describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario.

Evidence acquisition: Original articles were obtained from literature search in PubMed, MEDLINE, and OVID; pertinent articles were reviewed.

Results: These recommendations are based on published evidence and professional society guidelines. Antibiotic prophylaxis following manual placenta removal should include 1-time combination of ampicillin 2 g intravenously (IV) or cefazolin 1 g IV, plus metronidazole 500 mg IV. Antibiotic prophylaxis before postpartum dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade should include 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. If the patient in any of the above scenarios has received group B Streptococcus prophylaxis, then only metronidazole is recommended. Further randomized clinical trials are needed to optimize these regimens.

Conclusions: Uterine exploration or instrumentation increases the risk of postpartum endometritis and requires antibiotic prophylaxis. For manual placenta removal, we recommend 1-time combination of ampicillin 2 g IV or cefazolin 1 g IV, plus metronidazole 500 mg IV. For dilation and curettage, manual vacuum aspiration, and intrauterine balloon tamponade, we recommend 1-time combination of ampicillin 2 g IV plus metronidazole 500 mg IV. For patients who already received antibiotic prophylaxis for group B Streptococcus, we recommend 1-time dose of metronidazole 500 mg IV.

Relevance: Providers can utilize our guidelines to prevent postpartum endometritis in these scenarios requiring postpartum uterine exploration and/or instrumentation.

产后子宫探查或仪器检查后的抗生素建议。
重要性:多种产后情况需要子宫探查或器械。这些可能会将细菌引入子宫,增加子宫内膜炎的风险。在这些情况下使用抗生素的数据有限,导致指南很少,护理也不一致。目的:描述需要子宫探查和/或器械的产后情况,回顾抗生素预防的数据,并描述每种情况的抗生素建议。证据获取:原始文章来源于PubMed、MEDLINE和OVID的文献检索;对相关文章进行了综述。结果:这些建议是基于已公布的证据和专业协会的指导方针。手动胎盘摘除后的抗生素预防应包括1次注射2 g氨苄青霉素静脉注射(IV)或1 g头孢唑林静脉注射加甲硝唑500 mg IV。产后扩张和刮宫、手动真空抽吸和宫内球囊填塞前的抗生素预防应该包括1次加用2 g氨苄西林静脉注射加500 mg甲硝唑IV。如果患者在上述任何一种情况下接受了B组链球菌预防治疗,则建议仅使用甲硝唑。需要进一步的随机临床试验来优化这些方案。结论:子宫探查或子宫内固定会增加产后子宫内膜炎的风险,需要预防抗生素。对于手动胎盘切除,我们建议1次联合使用氨苄青霉素2 g IV或头孢唑林1 g IV,再加上甲硝唑500 mg IV。对于扩张和刮宫、手动真空抽吸和宫内球囊填塞,我们建议一次联合使用青霉素2 g IV+甲硝唑500 mg IV.对于已经接受B组链球菌抗生素预防的患者,我们建议1次剂量的甲硝唑500 mg IV。相关性:在需要产后子宫探查和/或器械的情况下,提供者可以利用我们的指南来预防产后子宫内膜炎。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.70
自引率
3.20%
发文量
245
审稿时长
>12 weeks
期刊介绍: ​Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.
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