Timing of Intravenous Prophylactic Antibiotic Agents for Cesarean Delivery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Surg Infect (Larchmt). 2023 May;24(4):303-310. doi: 10.1089/sur.2022.389.


Background: Prophylactic antibiotic administration has been used to reduce infectious morbidities in cesarean deliveries. However, no consensus on the timing has been reached. We performed this review to compare maternal and neonatal infectious morbidities of antibiotic administration before skin incision and after cord clamping. Methods: PubMed, EMBASE, MEDLINE, Cochrane Library, and Web of Science databases were searched. Only randomized controlled trials (RCTs) comparing the use of antibiotic agents pre-operatively and after cord clamping were included. Characteristics and results of the included studies were extracted, and risks of bias were assessed. A fixed-effect model was applied to estimate the relative risks (RRs) for outcomes. Results: Sixteen RCTs, including 8,027 women and 7,131 newborns, met the selection criteria. Pre-operative administration of antibiotic agents was associated with a reduction in the risk of endometritis (RR, 0.52; 95% confidence interval [CI], 0.37-0.72) and wound complications (RR, 0.54; 95% CI, 0.42-0.69), compared with administration after cord clamping. No differences were observed in the rate of febrile illness (RR, 0.79; 95% CI, 0.59-1.05), urinary tract infection (RR, 0.92; 95% CI, 0.64-1.32), neonatal intensive care unit (NICU) admission (RR, 0.94; 95% CI, 0.79-1.12), and neonatal sepsis (RR, 0.83; 95% CI, 0.61-1.14). Conclusions: The present study showed that prophylactic antibiotic agent administration before skin incision can reduce the risk of endometritis and wound complications while not increasing that of NICU admission and neonatal sepsis compared with administration after cord clamping.

Keywords: cesarean delivery; endometritis; prophylactic antibiotic administration; timing; wound complication.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis / methods
  • Endometritis* / drug therapy
  • Endometritis* / prevention & control
  • Female
  • Humans
  • Infant, Newborn
  • Neonatal Sepsis* / drug therapy
  • Pregnancy
  • Randomized Controlled Trials as Topic
  • Surgical Wound Infection / prevention & control


  • Anti-Bacterial Agents