General principles and indications

Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Obstetric procedures and their requirement for surgical antibiotic prophylaxis for the indications for surgical prophylaxis for obstetric procedures. For recommendations for prophylaxis for repair of obstetric anal sphincter injuries (including third- or fourth-degree perineal tears), see Prophylaxis for repair of obstetric anal sphincter injuries.

For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.

Table 1. Obstetric procedures and their requirement for surgical antibiotic prophylaxis

Procedures

Is surgical antibiotic prophylaxis indicated?

assisted vaginal delivery

YES

caesarean section, elective or nonelective

YES even if the patient is receiving antibiotics for preterm prelabour rupture of membranes [NB1]

Note:

NB1: For patients receiving intrapartum prophylaxis against Streptococcus agalactiae or treatment for intra-amniotic infection, additional surgical antibiotic prophylaxis is required, unless the antibiotic regimen has activity against the organism(s) most likely to cause postoperative infection (eg cefazolin, clindamycin plus gentamicin) (see Caesarean section, below).