Overview

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.

Contents

• Acknowledgements
• Acronyms and abbreviations
• Executive summary
• 1. Introduction
  • 1.1. Background
  • 1.2. Rationale and objectives
  • 1.3. Target audience
  • 1.4. Scope of the recommendation
  • 1.5. Persons affected by the recommendation
• 2. Methods
  • 2.1. Contributors to the guideline
  • 2.2. Identification of priority questions and outcomes
  • 2.3. Evidence identification and retrieval
  • 2.4. Certainty assessment and grading of the evidence
  • 2.5. Formulation of the recommendation
  • 2.6. Management of declarations of interests
  • 2.7. Decision-making during the GDG meetings
  • 2.8. Document preparation
  • 2.9. Peer review
• 3. Guiding principles, best practice, recommendation and supporting evidence
  • 3.1. Guiding principles and best practice
  • 3.2. Recommendation and supporting evidence
• 4. Dissemination, adaptation and implementation of the recommendation
  • 4.1. Recommendation dissemination
  • 4.2. Adaptation
  • 4.3. Implementation considerations
• 5. Research implications
• 6. Applicability issues
  • 6.1. Anticipated impact on the organization of care and resources
  • 6.2. Monitoring and evaluating guideline implementation
• 7. Updating the recommendation
• 8. References
• Annex 1. External experts and WHO staff involved in the preparation of the recommendation
• Annex 2. Priority outcomes used in decision-making
• Annex 3. Summary and management of declared interests from GDG members
• Annex 4. Evidence-to-decision framework

Suggested citation:

WHO recommendation on prophylactic antibiotics for women undergoing caesarean section. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

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