Why all women who need a forceps delivery should be given antibiotics

New mothers who have an assisted birth should all be given antibiotics to halve their risk of sepsis, a major study has found.

Giving women a preventative dose of antibiotics as a matter of course would cut maternal infections by 7,000 a year in the UK, new research shows.

Experts said the NHS and the World Health Organisation should update their guidelines so women routinely receive antibiotics if they have an assisted vaginal birth.

This is when forceps or a vacuum device called a ventouse suction cup are used to help deliver the baby.

Giving women a preventative dose of antibiotics as a matter of course would cut maternal infections by 7,000 a year in the UK

One in eight births in England are currently assisted, around 85,000 a year. One in five of these women go on to develop an infection.

However only one in ten women got an infection if they were given antibiotics straight after childbirth, scientists at the University of Oxford found.

The study, published in The Lancet, looked at 3,420 women who gave birth in 27 UK hospitals.

The women were split into two groups, with the first group given a single dose of intravenous amoxicillin, a type of penicillin, within six hours of giving birth. The second group were given a placebo.

Data showed that infections halved among the group who received antibiotics, and cases of sepsis reduced by 56 per cent.

Only 11 per cent of the 1619 women who received amoxicillin got an infection, compared to 19 per cent of the 1,606 women in the placebo group.


Antibiotics have been doled out unnecessarily by GPs and hospital staff for decades, fueling once harmless bacteria to become superbugs. 

The World Health Organization (WHO) has previously warned if nothing is done the world is heading for a ‘post-antibiotic’ era.

It claimed common infections, such as chlamydia, will become killers without immediate solutions to the growing crisis.

Bacteria can become drug resistant when people take incorrect doses of antibiotics or if they are given out unnecessarily. 

Chief medical officer Dame Sally Davies claimed in 2016 that the threat of antibiotic resistance is as severe as terrorism.

Figures estimate that superbugs will kill 10 million people each year by 2050, with patients succumbing to once harmless bugs.

Around 700,000 people already die yearly due to drug-resistant infections including tuberculosis (TB), HIV and malaria across the world. 

Concerns have repeatedly been raised that medicine will be taken back to the ‘dark ages’ if antibiotics are rendered ineffective in the coming years.

In addition to existing drugs becoming less effective, there have only been one or two new antibiotics developed in the last 30 years.

In September, the WHO warned antibiotics are ‘running out’ as a report found a ‘serious lack’ of new drugs in the development pipeline.

Without antibiotics, C-sections, cancer treatments and hip replacements will become incredibly ‘risky’, it was said at the time.

There were 11 cases of sepsis in the antibiotic group compared with 25 cases in the placebo group. Sepsis is the biggest cause of maternal death in the UK.

The study also found that giving new mothers a preventative dose of penicillin caused the overall use of antibiotics to drop by 17 per cent because fewer went on to develop infections.

For every additional 100 doses of antibiotic given as a preventative measure, 168 doses could be avoided due to fewer post-delivery infections.

Researchers said that adopting a policy of giving all women in this group antibiotics would cut overall antibiotic use and also save the NHS an average of £52.60 per birth.

They found the total average NHS costs six weeks after birth was £102.50 in the antibiotic group compared with £155.10 for women the given placebo.

The new study found that women given antibiotics had less pain and less chance of stitches getting infected or bursting. They were also much less likely to need a visit from a GP, nurse or midwife, or to go to hospital due to the way their wound was healing.

Lead researcher Professor Marian Knight, from the University of Oxford, said: ‘These findings highlight the urgent need to change current WHO antibiotic guidelines and other guidance from organisations in the UK, North America, and Australasia, that do not recommend routine antibiotic prophylaxis for assisted childbirth.

‘Pregnancy-associated infection is a major cause of death and serious illness. Almost one and five women develop an infection after assisted vaginal delivery and our results show that this could be reduced by almost half by a single dose of prophylactic antibiotic.

‘With increasing recognition of the need to reduce unnecessary caesarean births, the incentive to minimise the harms associated with other types of assisted delivery are even greater,’ says Professor Knight.

‘This simple intervention could also be used to prevent maternal infections in low- and middle-income countries in which intravenous antibiotics are available.’

Women who have a caesarean in NHS hospitals are given antibiotics, but the drugs are not routinely given for any other type of delivery. Giving antibiotics before caesarean section has been found to reduce wound infection, endometriosis, and serious maternal infection by 60 to 70 per cent.

In 2016, an estimated 19,500 women died because of pregnancy-related infections around the world, the researchers noted.

Even in high-income countries, infections account for one in 20 maternal deaths.

And for every woman who dies from pregnancy-related infection, another 70 women develop a severe infection that can cause long-term problems.

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