WHO recommendation on prophylactic antibiotics for women undergoing caesarean section
Publication year: 2021
Direct maternal infections around the time of childbirth account for about one tenth of
the global burden of maternal death. Women who develop peripartum infections are also
prone to severe morbidity, long-term disabilities such as chronic pelvic pain, fallopian tube
blockage and secondary infertility. Maternal infections before or during childbirth are also
associated with an estimated 1 million newborn deaths annually.
Several factors increase the risk of maternal peripartum infections, including pre-existing
maternal conditions (e.g. malnutrition, diabetes, obesity, severe anaemia, bacterial
vaginosis and group B streptococcus infections), as well as prolonged prelabour rupture
of membranes, multiple vaginal examinations, manual removal of the placenta, operative
vaginal birth and caesarean section. As such, the strategies to reduce maternal peripartum
infections and their short- and long-term complications have been directed at improving
infection prevention and control practices.
Globally, an effective intervention for preventing morbidity and mortality related to
maternal infection is the prophylactic and therapeutic use of antibiotics. However, the
misuse of antibiotics for obstetric conditions and procedures is common in many settings.
Inappropriate antibiotic use has implications for the global effort to prevent and reduce
antimicrobial resistance. The WHO global strategy for containment of antimicrobial resistance underscores the importance of appropriate use of antimicrobials at different levels of the health system to reduce the impact of antimicrobial resistance, while ensuring access to the best treatment available. WHO guidelines for health professionals and policy-makers on the need for antibiotics – and the type of antibiotics – for the prevention and treatment of maternal peripartum infections align with the WHO strategy and, if implemented, will improve maternal and newborn outcomes.
In 2019, the Executive Guideline Steering Group (GSG) for World Health Organization
(WHO) maternal and perinatal health recommendations prioritized updating of the existing
WHO recommendation on prophylactic antibiotics for women undergoing caesarean section
in response to the availability of new evidence. The recommendation in this document thus
supersedes the previous WHO recommendation on prophylactic antibiotics for women
undergoing caesarean section as published in the 2015 guideline WHO recommendations for the prevention and treatment of maternal peripartum infections.