Introduction
Whether prophylactic antibiotics should be administered before or after
cord clamping at caesarean section have been discussed. Today most
obstetric societies recommend administration 30-60 minutes before the
caesarean section (1). However, currently no studies are available
concerning pregnant women’s attitude toward these recommendations. As
intravenous antibiotics given before the caesarean section exposes the
fetus to antibiotics via placental transfer and remain in the infant up
to 24 hours postpartum, the practice is not without some potential risks
to the infant. These risk factors are not satisfyingly investigated.
The current recommendations are based on meta-analyses of multiple
studies that state a reduced risk of postpartum endometritis and
surgical site-infection, when administering antibiotics before cord
clamping (2–4). However, the individual RCTs are from 18 different
countries (2) of whom only one country, Austria, is comparable to Danish
healthcare standards. This large study conducted in Austria did not find
any significant risk reduction when antibiotic treatment was given
before umbilical cord clamping compared to after (5). In addition, the
primary outcomes were heterogeneous in the 18 RCTs, since some also
included evaluation of pneumonia, urinary tract infections,
pyelonephritis, and fever. These outcomes were not found to be affected
by the timing of the antibiotic prophylaxis (6). For those reasons, the
absolute risk reduction of postoperative infections after caesarean
delivery is presumably lower in Denmark than stated in aforementioned
meta-analyses. Infants born by caesarean delivery have an increased risk
of developing long-term complications such as asthma, allergies, and
atopic dermatitis (7). The causal mechanism is unknown, but previous
studies suggest that antibiotics may interfere with the natural
establishment of beneficial bacteria in the infant gut, which in turn
may be associated with increased risk of these disorders (8–10).
Currently no studies are available concerning pregnant women’s attitude
toward the recommendations on the timing of prophylactic antibiotics
during caesarean delivery.
A patient-centred approach in clinical research is becoming more common.
When involving specific patient groups and gauging their attitudes
towards relevant medical issues, it enables optimal healthcare by taking
personal opinions, preferences, and values into account (11). Hence the
aim of this study was to identify pregnant women’s attitude towards the
timing of antibiotic prophylaxis in caesarean delivery as no previous
studies have included women’s attitude towards such issues.