February 19th, 2020

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Do Prophylactic Antibiotics After Manual Exploration of the Uterus Decrease the Incidence of Postpartum Endometritis?
Authors:  Patricia L. Hudson, M.D., Wendy Y. Craig, Ph.D, and John S. Pulvino, M.D.
  OBJECTIVE: To evaluate whether antibiotics decrease the incidence of postpartum endometritis after manual exploration of the uterus.

STUDY DESIGN: All patients who underwent uterine exploration after vaginal delivery at a single tertiary medical center from December 2012–November 2015 were retrospectively analyzed to determine whether they were then treated for postpartum endometritis.

RESULTS: The study group included 242 women, who were 30.3 (5.4) years old with a BMI of 31.5 (6.6) kg/m2; most were white (88.8%), nonsmokers (92.8%), and multiparous (47.9%). Antibiotics were given at the time of exploration in 121 (50%) cases. Postpartum endometritis occurred in 9/242 (3.7%) patients, 6 of whom required inpatient admission for treatment. Among patients who had not previously received intrapartum antibiotics, the incidence of postpartum endometritis was significantly lower in women who received prophylactic antibiotics (0/85, 0%) as compared with those who did not (5/75, 6.7%) (p=0.022). The number needed to treat to prevent 1 case of endometritis among women who were not taking concurrent antibiotics for other conditions was estimated as 15 (95% confidence interval 8.1–97.9).

CONCLUSION: Prophylactic antibiotic use after uterine exploration was associated with a significantly decreased incidence of postpartum endometritis in women who had not received prior intrapartum antibiotics.
Keywords:  antibiotic prophylaxis; antibiotics; D&C; dilatation and curettage; endometritis; endomyometritis; extraction, obstetric; manual extraction; manual sweep; obstetric delivery; postpartum period; vaginal delivery
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