Abstract
Objective Trends in use of antibiotics during delivery hospitalizations complicated by (1)
3rd/4th degree vaginal lacerations, (2) manual placenta extraction, and (3) uterine
tamponade are not well characterized. The objective of this study was to analyze trends
in antibiotic use during vaginal delivery hospitalizations complicated by these three
clinical scenarios.
Study Design An administrative inpatient database was used to perform a serial cross-sectional
analysis of antibiotic administration during delivery hospitalizations in the United
States from January 2006 to March 2015. The primary outcome was receipt of antibiotics
during vaginal delivery hospitalizations complicated by (1) 3rd and 4th degree vaginal
lacerations, (2) manual placenta extraction, and (3) uterine tamponade. Patients with
other indications for antibiotics were excluded. The Cochran–Armitage test was used
to assess trends. Adjusted log linear regression analyses including demographic, hospital,
and obstetric factors were performed to analyze factors associated with antibiotic
receipt for each of these three clinical scenarios in both primary and sensitivity
analyses.
Results From 2006 to 2015 the rate of antibiotic administration during delivery hospitalizations
decreased from 43.1% in 2006 to 25.5% for 3rd and 4th degree lacerations and from
59.6% to 49.2% for manual extraction (p < 0.01). Administration of antibiotics in the setting of uterine tamponade decreased
from 48.6% in 2006 to 27.6% in 2009 before rising to 62.5% in the first quarter of
2015. In adjusted analyses, comparing the first quarter of 2015 to 2006 adjusted risk
ratios for antibiotic administration were 0.61 (95% confidence interval [CI] 0.56–0.66)
for 3rd and 4th degree vaginal lacerations, 0.76 (95% CI 0.53–1.09) for manual placental
extraction, and 0.83 (95% CI 0.76–0.92) for uterine tamponade.
Conclusion Antibiotics are not used consistently during vaginal deliveries complicated by 3rd/4th
degree lacerations, manual placenta extraction, and uterine tamponade. These findings
support that a significant opportunity exists for comparative effectiveness research
to assist in characterizing best practices.
Keywords
antibiotics - vaginal lacerations - placental extraction - endometritis
