Antibiotics reduce risks of complications after obstetric tear

Women treated with antibiotics within 24 hours of having an obstetric tear during childbirth have achieved a lower risk of larger/clinically relevant wound complications than women who do not receive such treatment, Danish researchers reported Oct. 29 in The BMJ today.

“Although no significant effect was seen for overall wound complications, prophylactic antibiotics significantly reduced the risk of clinically relevant wound complications in women with episiotomies and second-degree tears and should be considered in postpartum care,” the authors said.

As background, the authors noted that “Knowledge about wound complications in women with second degree tears is limited. Use of prophylactic antibiotics in instrumental deliveries [forceps and vacuum] is recommended by the World Health Organization, based on evidence suggesting a reduction in infection including wound complications.”

The researchers recruited 442 women aged 18 or over with episiotomies or second-degree tears after a vaginal delivery at a Copenhagen hospital between March and December 2023.

The investigators randomized the subjects to either three doses of amoxicillin (500 mg) with clavulanic acid (125 mg) or placebo, starting within six hours post- partum and repeated at eight-hour intervals.

Follow-up was conducted four to 14 days post-partum.

Outcome measures were wound complications, including separation of a surgically closed wound (dehiscence) with infection, and clinically relevant wound complications (those requiring further clinical care).

The investigators reported no significant difference in overall wound complications between the two groups (22% for antibiotics vs 29% for placebo, P=0.10).

But clinically relevant wound complications were significantly reduced (9% for antibiotics vs 17% for placebo, P=0.01).

Based on the new findings, the researchers estimated that for every 12 women given antibiotics, one clinically relevant wound complication would be prevented.

The authors concluded, “This study demonstrates that oral prophylactic antibiotics significantly reduce the risk of clinically relevant wound complications in women with episiotomy or second-degree tear.”

They added, “The findings provide evidence to support updating postpartum care guidelines to reduce the risk of clinically relevant wound complications for women with episiotomy or second-degree tear.