The recommendation in this document thus supersedes the previous WHO recommendation on routine antibiotic prophylaxis for women undergoing operative vaginal birth as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections.
The primary audience for this recommendation includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to the prevention and treatment of peripartum infections) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and obstetricians, as well as managers of maternal and child health programmes, and relevant staff in ministries of health and training institutions, in all settings.
Summary of clarifying remarks:
- “Operative vaginal birth” is the term used to describe delivery of the fetal head assisted by either vacuum extractor or forceps.
- Available evidence, from high-income countries, strongly supports the use of a single dose of intravenous amoxicillin (1 g) and clavulanic acid (200 mg) administered as soon as possible after birth and no more than 6 hours after birth.
- Intravenous amoxicillin and clavulanic acid may not be readily available or feasible to use in resource-limited settings and suggested that where this combination is not available, providers should consider the use of an appropriate class of antibiotics with similar spectrum of activity, based on local antimicrobial resistance patterns, safety profile (including allergies), the clinician’s experience with that class of antibiotics, availability and cost.
- This recommendation relates to the use of antibiotics for women who are undergoing operative vaginal birth and who are not receiving postpartum antibiotics for other indications.