Assisted vaginal delivery
A recent randomised controlled trial showed that in women who had an assisted (vacuum or forceps) vaginal delivery at 36 weeks or greater gestation, and had no other indication for antibiotic administration after delivery (such as prophylaxis for repair of obstetric anal sphincter injuries), a single postdelivery dose of amoxicillin+clavulanate (administered within 6 hours of delivery) significantly reduced the incidence of maternal infection1.
For prophylaxis for assisted vaginal delivery, use:
amoxicillin+clavulanate 1+0.2 g intravenously, as a single dose as soon as possible after assisted vaginal delivery. surgical prophylaxis, assisted vaginal delivery amoxicillin + clavulanate
The efficacy of prophylaxis administered to women less than 36 weeks’ gestation or more than 6 hours after delivery is not known.
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use:
cefazolin 2 g intravenously, as a single dose as soon as possible after assisted vaginal delivery surgical prophylaxis, assisted vaginal delivery cefazolin
PLUS
metronidazole 500 mg intravenously, as a single dose as soon as possible after assisted vaginal delivery. surgical prophylaxis, assisted vaginal delivery metronidazole
For patients with immediate severe or delayed severe hypersensitivity to penicillins, seek expert advice.