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Release Date: 07/09/2015

A team of researchers has published a clinical trial in Obstetrics & Gynecology, “Cefazolin prophylaxis in obese women undergoing cesarean delivery: A randomized controlled trial,” aiming to clarify the use of prophylactic antibiotic use during cesarean delivery of obese women. Lindsay Maggio, MD, a fellow in the Division of Maternal-Fetal Medicine at Women & Infants Hospital; Melissa DaCosta, PharmD, of the Department of Pharmacy at Women & Infants; Dwight J. Rouse, MD, principal investigator for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Research Network, and professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University; Brenna L. Hughes, MD, chief of the Women's Infectious Diseases Consultative Service at Women & Infants and an associate professor of obstetrics and gynecology at the Alpert Medical School; and David P Nicolau, PharmD, at the Center for Anti-Infective Research and Development at Hartford Hospital.

“The hypothesis was that the prophylactic antibiotic dose is not sufficient to reach a high enough concentration in the adipose tissue of obese women. Therefore, it would be ineffective in minimizing infection,” explained Dr. Maggio. “Women in the study agreed to be randomly assigned to receive either the standard two gram cefazolin dose or an increased three gram dose. We then measured the cefazolin concentrations in the adipose tissue. We found that both doses of antibiotics had similar adipose tissue concentrations. In other words, the higher dose of prophylactic antibiotic failed to achieve significantly higher adipose tissue concentrations, which could mean that it may not be any better at preventing infections.”

These findings are important because new recommendations say that obese women undergoing cesarean delivery should receive a higher dose of the antibiotic cefazolin to prevent surgical site infection. In obese women undergoing cesarean delivery, prophylaxis with this higher dose of 3g of cefazolin did not significantly increase adipose tissue concentration. Thus, our data do not support the new recommendations for 3g dosing.

About Obstetrics & Gynecology

Obstetrics & Gynecology is the Official Publication of the American College of Obstetricians and Gynecologists (ACOG). Popularly known as "The Green Journal," Obstetrics & Gynecology publishes original articles and research studies on: scientific advances, new medical and surgical techniques, obstetric management, and clinical evaluation of drugs and instruments. Obstetrics & Gynecology is the most complete and reliable source of information on current developments in women's health care.

About Women & Infants Hospital

Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation’s leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women’s medicine, Women & Infants is the 12th largest stand-alone obstetrical service in the country and the largest in New England with approximately 8,500 deliveries per year. A Designated Baby-Friendly® USA hospital, U.S.News & World Report 2014-15 Best Children’s Hospital in Neonatology and a 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened what was at the time the country’s largest, single-family room neonatal intensive care unit.

Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation’s first mother-baby perinatal psychiatric partial hospital, as well as the nation’s only fellowship program in obstetric medicine.

Women & Infants has been designated as a Breast Imaging Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute’s Gynecologic Oncology Group and the Pelvic Floor Disorders Network.
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