Prophylactic antibiotics for manual removal of retained placenta during vaginal birth: a systematic review of observational studies and meta-analysis

BMC Pregnancy and Childbirth

Rintaro Mori²  Olufemi T. Oladapo¹  Toshiyuki Swa⁴  Erika Ota²  Alexander J. Q. Parsons³  Ezinne C. Chibueze² 

[1] Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland;Department of Health Policy, National Center for Child Health and Development, 10-1-2 Okura, Setagaya-ku 157-8535, Tokyo, Japan;Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan;Graduate School of Human Sciences, Osaka University, Osaka, Japan

关键词: Meta-analysis;    Manual removal;    Systematic review;    Vaginal birth;    Retained placenta;    Antibiotic prophylaxis;   

Others  :  1234506
DOI  :  10.1186/s12884-015-0752-4

 received in 2015-07-24, accepted in 2015-11-21,  发布年份 2015

【 摘 要 】

Background

Manual removal of the placenta is an invasive obstetric procedure commonly used for the management of retained placenta. However, it is unclear whether antibiotic prophylaxis is beneficial in preventing infectious morbidity. We conducted a systematic review to determine the efficacy and safety of routine use of antibiotics for preventing adverse maternal outcomes related to manual placenta removal following vaginal birth.

Methods

A detailed search of MEDLINE, EMBASE, Cochrane library and the CINAHL databases was conducted for non-randomized studies involving women undergoing manual placenta delivery after vaginal births and where antibiotic prophylaxis use was compared with no treatment or placebo to prevent maternal infection. Search terms including ‘delivery, obstetric’, ‘placenta, retained’, ‘anti-infective agents’, and ‘chemoprevention’ were used.

Results

Of the 407 citations that resulted after elimination of duplicates, 81 full texts were potentially eligible after independent assessment of the title and abstracts. Independent review of the full texts identified three eligible cohort studies which were retrospective in design. These studies contained data on two of the pre-specified outcomes, endometritis and puerperal fever. Other secondary outcomes such as perineal infection and/or any infection, hospital stay duration, sepsis, hemorrhage >1000 ml or hospital readmissions were not reported on excluding puerperal fever.

A meta-analysis showed no significant reduction in the incidence of endometritis (odds ratio [OR] 0.84, 95 % confidence interval [CI] 0.38 to 1.85, three studies, 567 women) and puerperal fever (OR 0.99, 95 % CI 0.38 to 2.27, one study, 302 women).

Conclusions

There is currently no evidence to suggest beneficial effects for routine antibiotic use in women undergoing manual placental removal following vaginal birth. In appropriate settings, further research is required to determine whether a policy of routine antibiotic prophylaxis for the procedure should be maintained or discouraged.

【 授权许可】

   
2015 Chibueze et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Davison JM, Baylis PH. Plasma oxytocin during third stage of labour: comparison of natural and active management. BMJ. 1988; 297(6642):167-9.
• [2]Cutner A, Latimer J, Beard R. Management of the third stage of labour in women at low risk of postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993; 48(1):19-22.
• [3]Weeks AD. The retained placenta. Afr Health Sci. 2001; 1(1):36-41.
• [4]World Health Organization. Maternal and Child Health Unit. The Prevention and management of postpartum haemorrhage: report of a technical working group, Geneva 3-6 July, 1989 WHO/MCH. 1990; p. 20.
• [5]Ely JW, Rijhsinghani A, Bowdler NC, Dawson JD. The association between manual removal of the placenta and postpartum endometritis following vaginal delivery. Obstet Gynecol. 1995; 86(6):1002-6.
• [6]Weeks AD. The retained placenta. Best Pract Res Clin Obstet Gynaecol. 2008; 22(6):1103-17.
• [7]Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006; 368(9542):1189-200.
• [8]Loeffler F. Postpartum haemorrhage and abnormalities of the third stage of labour. Turnbull’s obstetrics. 2nd ed. Churchill Livingstone, Edinburgh; 1995.
• [9]Dipiro JT, Bivins BA, Record KE, Bell RM, Griffen WO. The prophylactic use of antimicrobials in surgery. Curr Probl Surg. 1983; 20(2):69-132.
• [10]Kibler MP, Micholet S, Magnin G, Ducroz B, Toullat G, Bernard JP et al.. The value of antibiotic prophylaxis during intrauterine procedures during vaginal delivery. A comparative study of 500 patients. J Gynecol Obstet Biol Reprod. 1990; 19(7):909-18.
• [11]Hemsell DL. Prophylactic antibiotics in gynecologic and obstetric surgery. Rev Infect Dis. 1991; 13 Suppl 10:S821-41.
• [12]World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012. p. 4.
• [13]Chongsomchai C, Lumbiganon P, Laopaiboon M. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth. Cochrane database of Syst Rev. 2014;CD004904.
• [14]Higgins JPT, Deeks JJ, Altman DG, Higgins JPT, Green S, editors. Chapter 13: Including non-randomised studies. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.1 (updated September 2008) The Cochrane Collaboration; 2008.
• [15]Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9.
• [16]Gibbs RS, Castaneda YS, Ramzy I. Endometritis following vaginal delivery. Obstet Gynecol. 1980; 56(5):555-8.
• [17]Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa (ON): Ottawa Health Research Institute; 1999.
• [18]Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.
• [19]Brozek J, Oxman AD, Schünemann H. GRADEprofiler [Computer Program] Version 3.6 for Windows. 2011;. http://ims. cochrane.org/revman/gradepro webcite
• [20]Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P et al.. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336(7650):924-6.
• [21]Katsulov A. Antibiotic prophylaxis in obstetrics. Akush Ginekol. 1983; 22(5):394-400.
• [22]Rechlin D, Wolf M, Koeniger W. Value of the preventive use of antibiotics following vaginal obstetric operations. Zentralbl Gynakol. 1987; 110(9):570-4.
• [23]Tandberg A, Albrechtsen S, Iversen O. Manual removal of the placenta, Incidence and clinical significance. Acta Obstet Gynecol Scand. 1999; 78(1):33-6.
• [24]Shlaes DM, Gerding DN, John JF, Craig WA, Bornstein DL, Duncan RA et al.. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis. 1997; 25(3):584-99.