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metronidazole for antibiotic prophylaxis at cesarean delivery
quality of care for multiple gestations, a retrospective review of low-risk twin gestations was conducted. Methods: All low-risk twin pregnancies delivered by private and MFM/resident services in 1990 –1997 were identified, pertinent data obtained from chart review, and results summarized. Results: Of the low-risk twin pregnancies (n ⫽ 491), 73% were seen by private services, 8.5% by MFM, and 18% by resident. Resident patients had a lower average maternal age and less infertility and were higher in parity and gravidity. A greater proportion of MFM patients had significant past medical histories, and more had undergone selective reduction. There was an increased use of oral tocolytics, a higher birth weight, and a higher mean gestational age in the private group. Total rate of cesarean deliveries for private patients was higher when compared with resident/MFM (52%–37%). The rate of combined procedures (vaginal followed by cesarean delivery) was significantly different with 4/90 resident/ MFM and 33/151 private services second twins delivered abdominally (P ⫽ 0.02). A greater proportion of breeches were delivered vaginally, and there were more instrumental vaginal deliveries in the resident/MFM group (P ⫽ 0.02). Perinatal morbidity was not different among the groups. Conclusions: Outcome results are similar among private, MFM, and resident services. Differences in practice patterns result in a higher private services cesarean delivery rate. Good outcomes for both groups reflect adherence to management protocols. Use of version and inexperience with breech extraction were major contributors to the higher private cesarean delivery rate.
Cefazolin Versus Cefazolin/ Metronidazole for Antibiotic Prophylaxis at Cesarean Delivery Norman L. Meyer, MD University of Tennessee, Memphis, TN
Kim Scott, MD, Keehn Hosier, MD, and Baha Sibai, MD Objective: To evaluate the efficacy and costs of cefazolin, compared with the broader spectrum and less expensive regimen of cefazolin plus metronidazole when used for prophylaxis at cesarean delivery. Methods: Women undergoing cesarean delivery who did not demonstrate exclusion criteria were randomly selected to receive either cefazolin, 2 g, (average wholesale price $5.66) or cefazolin, 1 g, plus metronidazole, 500 mg, (average wholesale price $4.83) intravenously for prophylaxis after umbilical cord clamping. Women who developed postoperative infection were generally treated with a combination of ampicillin/gentamicin/clindamycin (average wholesale price $10.60/day). Results: There were 37 cases of postoperative endomyometritis in 160 women enrolled in the study (23% postoperative infection rate).
74S Wednesday Posters
Cefazolin (n ⫽ 81) Hospital days
6.17 ⫾ 5.2
Postoperative days
4.46 ⫾ 4.7
Antibiotic days
1.98 ⫾ 5.2
Infections
26 (32%)
Estimated antibiotic cost
$553.39
Cefazolin metronidazole (n ⫽ 79) 4.89 ⫾ 2.8 (P ⫽ 0.05) 3.12 ⫾ 0.8 (P ⫽ 0.01) 0.4 ⫾ 1.04 (P ⫽ 0.009) 11 (14%) (P ⫽ 0.01) $52.06
Conclusions: Metronidazole plus cefazolin results in less postoperative infections, decreased hospitalization, and lower costs than cefazolin alone when used for prophylaxis at cesarean delivery.
Catastrophic Uterine Rupture: Maternal and Fetal Characteristics Cortney Kirkendall Childbirth Injury Prevention Foundation, Pasadena, CA
I. Jauregui, J. O. Kim, and J. Phelan Objective: To describe the maternal and fetal characteristics of 81 patients with catastrophic uterine rupture. Methods: From a national registry of brain-injured neonates, cases were obtained from patients with uterine rupture sufficient to produce fetal brain injury or death. Results: Of the 81 patients with uterine rupture, the number of prior cesarean deliveries were as follows: 0 –9 (11%); 1– 49 (61%); 2–22 (27%); and 3–1 (1%). Maternal complications included: death, 2 (3%); bladder/ureteral injury, 14 (17%); hysterectomy, 12 (15%); anemia, 48 (59%); transfusion, 27 (33%); bowel laceration, 1 (1%); or febrile, 23 (28%). In these 81 uterine ruptures, the rupture site was at the prior incision, 42 (68%), at a nonscar site, 17 (27%), or had no prior incision, 3 (5%). Placental separation occurred in 94%. Of the 82 fetuses, 64 (79%) were partially (27 [33%]) or completely (37 [46%]) extruded into the maternal abdomen. With the exception of one neonate, all Apgar scores at 1 and 5 minutes were less than 7. Neonatal outcome was as follows: brain damage, 59 (72%), intrapartum death, 5 (6%), neonatal death, 14 (17%), or death within 1 year (4 –5%). Conclusions: When uterine rupture occurs, significant maternal and perinatal morbidity and mortality can occur. Repair of the uterine rupture rather than hysterectomy can often times be accomplished. Finally, perinatal morbidity and mortality appeared to be associated with partial or complete fetal expulsion and partial or complete placental separation.
Obstetrics & Gynecology
Cefazolin Versus Cefazolin/ Metronidazole for Antibiotic Prophylaxis at Cesarean Delivery Norman L. Meyer, MD University of Tennessee, Memphis, TN
Kim Scott, MD, Keehn Hosier, MD, and Baha Sibai, MD Objective: To evaluate the efficacy and costs of cefazolin, compared with the broader spectrum and less expensive regimen of cefazolin plus metronidazole when used for prophylaxis at cesarean delivery. Methods: Women undergoing cesarean delivery who did not demonstrate exclusion criteria were randomly selected to receive either cefazolin, 2 g, (average wholesale price $5.66) or cefazolin, 1 g, plus metronidazole, 500 mg, (average wholesale price $4.83) intravenously for prophylaxis after umbilical cord clamping. Women who developed postoperative infection were generally treated with a combination of ampicillin/gentamicin/clindamycin (average wholesale price $10.60/day). Results: There were 37 cases of postoperative endomyometritis in 160 women enrolled in the study (23% postoperative infection rate).
74S Wednesday Posters
Cefazolin (n ⫽ 81) Hospital days
6.17 ⫾ 5.2
Postoperative days
4.46 ⫾ 4.7
Antibiotic days
1.98 ⫾ 5.2
Infections
26 (32%)
Estimated antibiotic cost
$553.39
Cefazolin metronidazole (n ⫽ 79) 4.89 ⫾ 2.8 (P ⫽ 0.05) 3.12 ⫾ 0.8 (P ⫽ 0.01) 0.4 ⫾ 1.04 (P ⫽ 0.009) 11 (14%) (P ⫽ 0.01) $52.06
Conclusions: Metronidazole plus cefazolin results in less postoperative infections, decreased hospitalization, and lower costs than cefazolin alone when used for prophylaxis at cesarean delivery.
Catastrophic Uterine Rupture: Maternal and Fetal Characteristics Cortney Kirkendall Childbirth Injury Prevention Foundation, Pasadena, CA
I. Jauregui, J. O. Kim, and J. Phelan Objective: To describe the maternal and fetal characteristics of 81 patients with catastrophic uterine rupture. Methods: From a national registry of brain-injured neonates, cases were obtained from patients with uterine rupture sufficient to produce fetal brain injury or death. Results: Of the 81 patients with uterine rupture, the number of prior cesarean deliveries were as follows: 0 –9 (11%); 1– 49 (61%); 2–22 (27%); and 3–1 (1%). Maternal complications included: death, 2 (3%); bladder/ureteral injury, 14 (17%); hysterectomy, 12 (15%); anemia, 48 (59%); transfusion, 27 (33%); bowel laceration, 1 (1%); or febrile, 23 (28%). In these 81 uterine ruptures, the rupture site was at the prior incision, 42 (68%), at a nonscar site, 17 (27%), or had no prior incision, 3 (5%). Placental separation occurred in 94%. Of the 82 fetuses, 64 (79%) were partially (27 [33%]) or completely (37 [46%]) extruded into the maternal abdomen. With the exception of one neonate, all Apgar scores at 1 and 5 minutes were less than 7. Neonatal outcome was as follows: brain damage, 59 (72%), intrapartum death, 5 (6%), neonatal death, 14 (17%), or death within 1 year (4 –5%). Conclusions: When uterine rupture occurs, significant maternal and perinatal morbidity and mortality can occur. Repair of the uterine rupture rather than hysterectomy can often times be accomplished. Finally, perinatal morbidity and mortality appeared to be associated with partial or complete fetal expulsion and partial or complete placental separation.
Obstetrics & Gynecology