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#Grand Rounds

Antibiotics for Reducing Risk of Endometritis Following Intrauterine Balloon Tamponade

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BACKGROUND AND PURPOSE:

  • No guidelines or strong data exist regarding use of prophylactic antibiotics with intrauterine balloon tamponade (IBT)
  • Wong et al. (Amer J Perinatol, 2019) sought to determine whether prophylactic antibiotics at the time of IBT placement reduce risk for postpartum endometritis

METHODS:

  • Retrospective cohort study
  • Participants
    • IBT in place for ≥2 hours
    • No history of chorioamnionitis
  • Primary outome: Postpartum endometritis
  • Analyzed differences between the following 2 groups
    • Prophylactic antibiotics (at the time of IBT placement)
    • No prophylactic antibiotics

RESULTS:

  • 59 received prophylactic antibiotics | 54 did not receive antibiotics
  • Baseline characteristics similar between groups except mode of delivery
    • Cesarean section (p=0.03)
      • Antibiotic group 65% | No antibiotic group 44%
  • Most common antibiotic regimen
    • Cefazolin (93%): 1 g every 8 hours
    • Number of doses: 3 (median)

Endometritis (primary outcome)

  • Overall incidence: 15%
  • Greater incidence in the no antibiotic group (p < 0.002)
    • Prophylactic antibiotics: 5%
    • No antibiotics: 26%
    • odds ratio (OR) 6.53 (95% CI, 1.76–24.25)
  • Association remained after adjustment for antibiotics prior to delivery
    • aOR: 6.21 (95% CI, 1.62–23.77)
  • Mode of delivery
    • Association remained only for vaginal delivery (p = 0.005)
    • Prophylactic antibiotics: 0%
    • No antibiotics: aOR 14.45 (95% CI, 2.47-infinity)

CONCLUSION:

  • Prophylactic antibiotics were associated with a reduction in postpartum endometritis following intrauterine balloon tamponade

Learn More – Primary Sources:

Antibiotics during Intrauterine Balloon Tamponade Is Associated with a Reduction in Endometritis

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Related ObG Topics:

Postpartum Hemorrhage – Medications to Treat Uterine Atony 
Postpartum Hemorrhage Prophylaxis: The World Health Organization Recommendations
Does Vaginal Cleansing Prevent Endometritis Following Cesarean Section?
How Effective is Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage
What is the Optimal Duration of Intrauterine Balloon Tamponade?

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