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.