WHO recommendations for prevention and treatment of maternal peripartum infections

Published by World Health Organization on Apr 4, 2025

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Abstract

Language

en

PICOS

PICO 10.1

Population
Women on admission in labour
Intervention
Perineal shaving
Comparator
No perineal shaving
Outcomes

PICO 10.2

Population
Pregnant women undergoing labour monitoring
Intervention
Routine vaginal examination at intervals of four hours
Comparator
Shorter intervals
Outcomes

PICO 10.3

Population
Women in labour (excluding Group B Streptococcal and HIV)
Intervention
Chlorhexidine vaginal wash
Comparator
Sterile water vaginal wash
Outcomes

PICO 10.4

Population
Women in labour group B streptococcal infection
Intervention
Chlorhexidine (vaginal wash or gel/cream)
Comparator
placebo or no treatment
Outcomes

PICO 10.5

Population
Women in labour maternal Group B streptococcal colonization
Intervention
Intrapartum antibiotics
Comparator
Placebo or no treatment for GBS positive women
Outcomes

PICO 10.6

Population
Women in the second and third trimester
Intervention
Prophylactic antibiotics
Comparator
Placebo
Outcomes

PICO 10.7

Population
Women in preterm labour with intact membranes
Intervention
Any antibiotics
Comparator
No antibiotics
Outcomes

PICO 10.8

Population
Women in preterm labour with rupture membranes
Intervention
Any antibiotic
Comparator
Placebo
Outcomes

PICO 10.9

Population
Women with prelabour rupture of membranes at or near term (all women)
Intervention
Any antibiotic
Comparator
Pacebo or no antibiotic
Outcomes

PICO 10.10

Population
Women with prelabour rupture of membranes at or near term (subgrouped by timing of induction of labour)
Intervention
Any antibiotic
Comparator
No antibiotic
Outcomes

PICO 10.11

Population
Women with meconium-stained amniotic fluid during labour
Intervention
Antibiotic
Comparator
Placebo
Outcomes

PICO 10.12

Population
Women undergoing manual removal of retained placenta
Intervention
Antibiotic prophylaxis
Comparator
No treatment
Outcomes

PICO 10.13

Population
Women undergoing for operative vaginal delivery
Intervention
Any antibiotics
Comparator
No treatment
Outcomes

PICO 10.14

Population
Women undergoing operative vaginal deliveries
Intervention
Antibiotics prophylaxis
Comparator
No treatment
Outcomes

PICO 10.15

Population
Women with third- and fourth-degree perineal tear during vaginal birth
Intervention
Antibiotic prophylaxis
Comparator
No treatment
Outcomes

PICO 10.16

Population
Pregnant women with uncomplicated vaginal birth
Intervention
Antibiotic prophylaxis
Comparator
No antibiotic treatment
Outcomes

PICO 10.17

Population
Pregnant women with indications for caesarean section
Intervention
Preoperative vaginal cleansing with povidoneiodine
Comparator
No preoperative vaginal preparation with povidone-iodine
Outcomes

PICO 10.18

Population
Pregnant women with indications for caesarean section
Intervention
Preoperative vaginal cleansing with povidoneiodine
Comparator
No preoperative vaginal preparation with povidoneiodine
Outcomes

PICO 10.19

Population
Pregnant women with indications for caesarean section
Intervention
Preoperative vaginal cleansing with povidone-iodine
Comparator
No preoperative vaginal preparation with povidoneiodine
Outcomes

PICO 10.20

Population
Women undergoing caesarean section
Intervention
One-minute alcohol scrub with iodophor drape
Comparator
Five-minute iodophor scrub without drape
Outcomes

PICO 10.21

Population
Women undergoing caesarean section
Intervention
Chlorhexidine gluconate
Comparator
Povidone iodine
Outcomes

PICO 10.22

Population
Women undergoing caesarean section
Intervention
Parachlorometaxylenol with iodine
Comparator
Iodine alone
Outcomes

PICO 10.23

Population
Women undergoing caesarean section
Intervention
Drape after skin preparation
Comparator
No drape after skin preparation
Outcomes

PICO 10.24

Population
Women undergoing caesarean section
Intervention
One-minute alcohol scrub with iodophor drape
Comparator
Five-minute iodophor scrub without drape
Outcomes

PICO 10.25

Population
Women undergoing caesarean section
Intervention
Antibiotic prophylaxis
Comparator
No antibiotics
Outcomes

PICO 10.26

Population
Women undergoing caesarean section
Intervention
Antibiotics (by class of antibiotic)
Comparator
No antibiotic
Outcomes

PICO 10.27

Population
Women undergoing caesarean section (by type of caesarean section)
Intervention
Antibiotics
Comparator
No antibiotics
Outcomes

PICO 10.28

Population
Women undergoing cesarean section
Intervention
Prophylactic intravenous antibiotics administered before cesarean incision
Comparator
Intraoperative prophylactic intravenous antibiotic
Outcomes

PICO 10.29

Population
All women undergoing caesarean section
Intervention
Cephalosporins
Comparator
Penicillins
Outcomes

PICO 10.30

Population
Women undergoing caesarean section (by type of caesarean section)
Intervention
Cephalosporins
Comparator
Penicillins
Outcomes

PICO 10.31

Population
Women undergoing caesarean section (by timing of administration)
Intervention
Cephalosporins
Comparator
Penicillins
Outcomes

PICO 10.32

Population
Women undergoing caesarean section (by route of administration)
Intervention
Cephalosporins
Comparator
Penicillins
Outcomes

PICO 10.33

Population
Women undergoing caesarean section
Intervention
Cephalosporin (first generation)
Comparator
Penicillins (extended spectrum)
Outcomes

PICO 10.34

Population
Women undergoing caesarean section
Intervention
 Cephalosporin (first generation)
Comparator
Penicillins  (ampicillin)
Outcomes

PICO 10.35

Population
Women undergoing caesarean section
Intervention
Cephalosporin (second generation)
Comparator
Penicillins (extended-spectrum)
Outcomes

PICO 10.36

Population
Women undergoing caesarean section
Intervention
Cephalosporin (second generation)
Comparator
Penicillins (ampicillin)
Outcomes

PICO 10.37

Population
Women undergoing caesarean section
Intervention
Cephalosporin (third generation)
Comparator
Penicillins (extended-spectrum)
Outcomes

PICO 10.38

Population
Women undergoing caesarean section
Intervention
Cephalosporin (third generation)
Comparator
Penicillins (ampicillins)
Outcomes

PICO 10.39

Population
Women undergoing caesarean section
Intervention
Fluoroquinolones
Comparator
Penicillins
Outcomes

PICO 10.40

Population
Women undergoing caesarean seciton
Intervention
Fluoroquinolones
Comparator
Cephalosporins
Outcomes

PICO 10.41

Population
Women undergoing caesarean section
Intervention
Lincosamide + aminoglycoside
Comparator
Penicillins
Outcomes

PICO 10.42

Population
Women undergoing caesarean section
Intervention
Macrolids
Comparator
Cephalosporins
Outcomes

PICO 10.43

Population
Women undergoing caesarean section
Intervention
Gentamicin/ nitroimidazole
Comparator
Standard cocktail of antibiotics
Outcomes

PICO 10.44

Population
Women who had an episiotomy for vaginal birth
Intervention
Routine antibiotic prophylaxis
Comparator
No routine antibiotic prophylaxis
Outcomes

PICO 10.45

Population
Women undergoing cesarean section
Intervention
Preoperative prophylactic intravenous antibiotics
Comparator
Intraoperative prophylactic intravenous antibiotic
Outcomes

PICO 20.1

Population
Women diagnosed with intra-amniotic infection/chorioamnionitis
Intervention
Antibiotics
Comparator
Other regimen or dosage of antibiotic
Outcomes

PICO 20.2

Population
Women diagnosed with intra-amniotic infection/chorioamnionitis
Intervention
Antibiotics
Comparator
No treatment during postpartum period
Outcomes

PICO 20.3

Population
Women diagnosed with intra-amniotic infection/chorioamnionitis
Intervention
Ampicillin during labour plus postpartum clindamycin/ gentamicin
Comparator
Ampicillin during labour only
Outcomes

PICO 20.4

Population
Women diagnosed with intra-amniotic infection/chorioamnionitis
Intervention
Antibiotics (short duration) in postpartum
Comparator
Antibiotics (long duration) in postpartum
Outcomes

PICO 20.5

Population
Women diagnosed with intra-amniotic infection/chorioamnionitis
Intervention
Intrapartum ampicillin/ gentamicin
Comparator
Postpartum ampicillin/ gentamicin
Outcomes

PICO 20.6

Population
Women diagnosed with postpartum endometritis
Intervention
Lincosamide plus aminoglycoside
Comparator
Any other regimen
Outcomes

PICO 20.7

Population
Women diagnosed with postpartum endometritis
Intervention
Aminoglycoside plus penicillin or ampicillin
Comparator
Any other regimen
Outcomes

PICO 20.8

Population
Women diagnosed with postpartum endometritis
Intervention
Beta-lactamase inhibitor combination
Comparator
Any other regimen
Outcomes

PICO 20.9

Population
Women diagnosed with postpartum endometritis
Intervention
Aztreonam plus clindamycin
Comparator
Any other regimen
Outcomes

PICO 20.10

Population
Women diagnosed with postpartum endometritis
Intervention
Agent with longer half-life
Comparator
Similar agent with shorter half-life
Outcomes

PICO 20.11

Population
Women diagnosed with postpartum endometritis
Intervention
Metronidazole plus gentamicin
Comparator
Any other regimen
Outcomes

PICO 20.12

Population
Women diagnosed with postpartum endometritis
Intervention
Once daily gentamicin dosing
Comparator
Thrice-daily (eight-hourly) gentamicin dosing
Outcomes

PICO 20.13

Population
Women diagnosed with postpartum endometritis
Intervention
Continued oral treatment after intravenous antibiotic course
Comparator
No treatment after intravenous antibiotic course
Outcomes

PICO 20.14

Population
Women diagnosed with postpartum endometritis
Intervention
Poor activity against penicillin-resistant anaerobic bacteria
Comparator
Good activity against penicillin resistant anaerobic bacteria
Outcomes

PICO 20.15

Population
Women diagnosed with postpartum endometritis
Intervention
Oral ofloxacin/clindamycin
Comparator
Intravenous clindamycin/gentamicin
Outcomes