The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
The following recommendations are based on good and consistent scientific evidence (Level A):
- All high-risk patients undergoing cesarean delivery should be given antibiotic prophylaxis.
- For prophylaxis with cesarean delivery, narrow-spectrum antibiotics, such as a first-generation cephalosporin, should be used.
- Antibiotic prophylaxis may be considered for patients with premature rupture of membranes (PROM), particularly in cases of extreme prematurity, to prolong the latency period between membrane rupture and delivery.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- Evidence is insufficient to recommend perioperative antibiotic prophylaxis at the time of prophylactic or emergency cervical cerclage.
- Prophylaxis for bacterial endocarditis is optional in patients with the following cardiac conditions who are undergoing uncomplicated obstetric delivery: prosthetic cardiac valves, prior bacterial endocarditis, complex cyanotic congenital cardiac malformations, and surgically constructed systemic pulmonary shunts or conduits.
- Patients with the above cardiac conditions who are undergoing obstetric delivery complicated by intraamniotic infection should receive prophylaxis.
- Although the evidence is inconclusive, for low-risk patients undergoing cesarean delivery, use of prophylactic antibiotics is recommended.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
