Infectious Diseases of the Female Genital Tract
4th Edition

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ANTIBIOTIC PROPHYLAXIS IN OBSTETRICS AND GYNECOLOGY
Because infections have been nearly an every day encounter in a busy obstetric-gynecologic practice, there has been great interest in antibiotic prophylaxis for operative procedures in the specialty. Over the last three decades, a large body of data has accumulated to allow for the establishment of practical recommendations for use in many procedures. Quality standards have very recently been published for antimicrobial prophylaxis in all surgical procedures (1). In previous editions of this book, this chapter included detailed tables listing numerous publications and giving specific results of these individual tables. Because these studies are now aging and because antibiotic prophylaxis is so well established for many procedures, we have decided to eliminate these detailed and cumbersome tables and replace them with practice recommendations.
There are special conditions regarding the use of antibiotic prophylaxis in an obstetric-gynecologic population. First, nearly all obstetric and most gynecologic patients are healthy and free of serious underlying disorders. Second, because the lower genital tract is a contaminated field, operation through or adjacent to this field leads to a moderate to high incidence of infection (in the absence of antibiotic prophylaxis), but serious infection measured by abscess or death is unusual. Third, use of certain antimicrobials for prophylaxis in pregnancy is often contraindicated because of the potential for adverse effects on the fetus, newborn, or mother. In this chapter, antibiotic prophylaxis is defined as the use of antibiotics for the prevention of infection in the absence of current signs or symptoms of infection.