Antibiotics can prevent complications of childbirth

Yasser El-Sayed

A single dose of antibiotics can significantly aid healing of the severe tears that occur in vaginal tissues in women during many births, reported researchers from Lucile Packard Children's Hospital, the School of Medicine and Santa Clara Valley Medical Center.

The study is the first to show that the simple treatment can prevent many of the short- and long-term repercussions of this relatively common complication of childbirth.

As many as one in five women suffer severe tears in their vaginal tissues during childbirth. In the study, women who received the antibiotic endured roughly one-third as many infections or other wound-healing complications two weeks after surgical repair of their tears. Neena Duggal, MD, vice chair of obstetrics and gynecology at Santa Clara Valley Medical Center, designed and was the lead author of the study working with Packard Children's obstetricians Yasser El-Sayed, MD, and Kay Daniels, MD.

'Recovery from these tears can be painful and problematic,' said El-Sayed, who is also associate professor of obstetrics and gynecology and associate chief of maternal-fetal medicine at Stanford's School of Medicine. 'If you add an infection, or a breakdown of the surrounding tissues, it's a huge burden on the emotional and physical well-being of a new mother.'

The study was published in the June issue of Obstetrics and Gynecology. It was accompanied by an editorial in the same journal.

'This is very important news that will likely change obstetrical practice nationwide,' said Maurice Druzin, MD, chief of obstetrics and gynecology at Packard Children's and the Charles B. and Ann L. Johnson Professor in the medical school.

Vaginal tears, which occur between the vagina and the anus during childbirth, are classified in severity according to their length. Third-degree vaginal tears extend into the muscle of the anal sphincter and fourth-degree tears reach the rectum. The tears are surgically repaired immediately after delivery but subsequent infections and poor healing that sometimes occur can have lifelong consequences, including incontinence of stool or gas and sexual dysfunction.

Duggal, who is a clinical associate professor (affiliated) in obstetrics and gynecology at the School of Medicine, collaborated with Daniels and El-Sayed to conduct a randomized, double-blind study in 147 women who experienced third- or fourth-degree vaginal tears while delivering infants at either Packard Children's Hospital or Santa Clara Valley Medical Center. After agreeing to participate in the study, the women were randomly assigned to receive a one-time intravenous infusion of either the antibiotic or a placebo during the surgical repair of their tear from childbirth. Neither the women nor their physicians knew which intravenous treatment they received in the study.

The researchers found that four of 49 patients (8.2 percent) treated with antibiotics and 14 of 58 patients (24.1 percent) who received the placebo showed symptoms of infection or tissue breakdown two weeks after the repair. The remaining 40 women did not return for their scheduled follow-up appointments, but the difference between the two returning groups was statistically significant.

'We're excited because it's such a simple intervention,' said El-Sayed. The difference between the two groups persisted despite variability in surgical technique, suture and type of antibiotic.

Although the study was small, the results detected an important difference in outcome. Until now, many physicians have been divided as to whether antibiotic treatment was helpful for these women, and most health-care providers have made their own choices.

'At Packard,' said El-Sayed, 'antibiotic use was pretty hit-or-miss according to the preference of the physician. Personally, I didn't use it. But I certainly do now.' Physicians at Packard now routinely use antibiotics when repairing these types of tears.

Duggal, Daniels and El-Sayed collaborated with Aaron Caughey, MD, associate professor of obstetrics and gynecology at UC-San Francisco, on this study. Daniels is clinical associate professor of obstetrics and gynecology at Stanford's School of Medicine.

The study was funded by division and department funds from Stanford's Department of Obstetrics and Gynecology and Santa Clara Valley Medical Center.