Clinical Outcomes of Antibiotic Prophylaxis in Vaginal Delivery Women in Ramathibodi Hospital

Introduction: Bacterial infections in mothers and newborn babies during vaginal delivery and puerperium are associated with maternal and perinatal morbidity and mortality. The incidence rate of sepsis for mothers with live births in developing countries was 10.7% compared to developed countries with 4.7%. The World Health Organization recommended using antibiotics in order to prevent bacterial infections. However, the use of antibiotics for full term pregnancy with normal delivery was irrational. The definition of rational drug use by the World Health Organization is patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest to them and their community. Antibiotic prophylaxis in vaginal delivery of term labor (APL) is one of policies in rational drug use.

Purpose: This study aims: 1) To compare the percentage of using antibiotic prophylaxis in vaginal delivery women before and after using clinical practice guideline for antibiotic prophylaxis. 2) To compare the episiotomy wound infection rate in vaginal delivery women before and after using clinical practice guideline for antibiotic prophylaxis.

Methods: The retrospective study by collecting data from the electronic medical record program of the vaginal delivery mothers at Ramathibodi Hospital was performed between July, 2016 and October, 2017. There were 1,302 medical records of vaginal delivery mothers and were classified into 2 groups. The first group (621 mothers) was assigned to the experimental group and cared by the clinical practice guideline for using antibiotic prophylaxis in postpartum women (CPG), while the rest (681 mothers) was assigned to the control group and cared by the conventional care before using the CPG, Measuring tools consisted of The clinical practice guideline for using antibiotic prophylaxis in postpartum women. The content validity of the CPG was examined by two experts; and The records of normal delivery form for data collection. Data were analyzed by descriptive statistics and Chi square test by SPSS/FW version 18.

Results: The study demonstrated that the experimental group with care by the clinical practice guideline for using antibiotic prophylaxis in postpartum women had significantly lower rate of using antibiotic prophylaxis than the control group with the conventional care before using the CPG (P < .001). There was no significant difference in episiotomy wound infection rate between the experimental and control groups (P = .227).

Conclusion: The results of this study support that the clinical practice guideline for using antibiotic prophylaxis would be certainly helpful for vaginal delivery mothers in rational drug use. The rational use of antibiotics would be unnecessary for prophylaxis in term labor mothers after birth via vaginal delivery.