For an elective caesarean section, when should preoperative antibiotic prophylaxis be administered for maximum reduction of postpartum endometritis and surgical site infection?

• A After closure of the uterine incision but before abdominal closure
• B Immediately after clamping of the umbilical cord
• C Within 60 minutes before skin incision ✓
• D Only after surgery if membranes were ruptured for more than 6 hours

Explanation

Randomised trials and Cochrane reviews show that administering the antibiotic within 60 minutes before skin incision significantly lowers endometritis and wound infection compared with giving it after cord clamping, without harming the neonate. This preincision timing is now recommended universally for both elective and emergency caesarean sections. Cord-clamp timing was traditional practice aimed at avoiding fetal drug exposure, but the evidence favours earlier administration.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.