{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T14:03:10Z","timestamp":1769522590437,"version":"3.49.0"},"reference-count":49,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effectiveness of a cesarean delivery (CD) bundle including preoperative vaginal preparation, cefazolin and azithromycin administration, compared with cefazolin alone, in reducing postoperative infections, among women undergoing CD during the second stage of labor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In August 2016, our departmental protocol for preventing infectious morbidity in second\u2010stage CD was revised from preoperative intravenous 2\u2009g cefazolin alone, to preoperative intravenous 2\u2009g cefazolin, intravenous 500\u2009mg azithromycin, and vaginal cleansing with povidone\u2010iodine. In this before\u2010and\u2010after study, the medical records of women who underwent CD during the second stage of labor were reviewed, comparing two time periods: January 2014 to August 2016 (control group, cefazolin alone) and November 2016 to January 2021 (CD bundle group). Obstetric characteristics, postoperative infections, and neonatal outcomes were compared between groups. Composite infectious morbidity was defined as one or more of: endometritis, surgical\u2010site infection (SSI), abscess, urinary tract infection, and postpartum fever.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, there were 5265 intrapartum CD, among them 457 were during the second stage of labor. The CD bundle group (<jats:italic>n<\/jats:italic>\u2009=\u2009331) had lower rates of endometritis, SSI, and composite infectious morbidity compared with the control group (<jats:italic>n<\/jats:italic>\u2009=\u2009126, 1.2% vs. 4.8%, <jats:italic>P<\/jats:italic>\u2009=\u20090.030; 3.0% vs. 7.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.049, 6.9% vs. 14.3%, <jats:italic>P<\/jats:italic>\u2009=\u20090.014, respectively). Neonatal outcomes did not differ between groups. Multivariable regression analysis adjusted for confounders revealed that the CD bundle reduced the risk for the composite infectious outcome, with adjusted odds ratio 0.08 (95% confidence interval 0.01\u20130.50).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In second\u2010stage CD, adding preoperative azithromycin and vaginal cleansing to cefazolin was efficacious in reducing postoperative infections.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.16194","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T08:35:07Z","timestamp":1738398907000},"page":"448-455","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The effectiveness of a cesarean delivery bundle with vaginal preparation, cefazolin, and azithromycin in reducing postoperative infections: A before\u2010and\u2010after 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