{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T08:35:08Z","timestamp":1782549308832,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,6,14]],"date-time":"2020-06-14T00:00:00Z","timestamp":1592092800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Antimicrobial prophylaxis during surgery aims to prevent post\u2010operative site infections. For fetal surgery, this includes the fetal and amniotic compartments. Both are deep compartments as drug equilibrium with maternal blood is achieved relatively late. Despite prophylaxis, chorio\u2010amnionitis or endometritis following ex utero intrapartum treatment or fetoscopy occur in 4.13% and 1.45% respectively of the interventions.<\/jats:p><jats:p>This review summarizes the observations on two commonly administered antimicrobials (cefazolin, clindamycin) for surgical prophylaxis during pregnancy, with emphasis on the deep compartments. For both compounds, antimicrobial exposure is on target when we consider the maternal and fetal plasma compartment. In contrast, amniotic fluid concentrations\u2010time profiles display a delayed and much more blunted pattern, behaving as deep compartment. For cefazolin, there are data that document further dilution in the setting of polyhydramnios. Along this deep compartment concept, there is some accumulation during repeated administration, modeled for cefazolin and observed for clindamycin. The relative underexposure to antimicrobials in amniotic fluid may be reflected in the pattern of maternal\u2010fetal complications after fetal surgery, and suggest that antimicrobial prophylaxis practices for fetal surgery should be reconsidered.<\/jats:p><jats:p>Further studies should be designed by a multidisciplinary team (fetal surgeons, clinical pharmacologists and microbiologists) to facilitate efficient evaluation of antimicrobial prophylaxis.<\/jats:p>","DOI":"10.1002\/pd.5753","type":"journal-article","created":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T10:09:58Z","timestamp":1590142198000},"page":"1178-1184","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Pregnancy\u2010related pharmacokinetics and antimicrobial prophylaxis during fetal surgery, cefazolin and clindamycin as examples"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9921-5105","authenticated-orcid":false,"given":"Karel","family":"Allegaert","sequence":"first","affiliation":[{"name":"Department of Development and Regeneration, Cluster Woman and Child KU Leuven  Leuven Belgium"},{"name":"Department of Pharmaceutical and Pharmacological Sciences KU Leuven  Leuven Belgium"},{"name":"Department of Pharmacy Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk E.","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Haaglanden MC  The Hague The Netherlands"},{"name":"Department of Medical Microbiology and Infectious Diseases Erasmus MC  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5029-7899","authenticated-orcid":false,"given":"Francesca","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, Cluster Woman and Child KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Schoenmakers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4920-945X","authenticated-orcid":false,"given":"Jan","family":"Deprest","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, Cluster Woman and Child KU Leuven  Leuven Belgium"},{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"},{"name":"Institute for Woman's Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit C.P.","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2017.06.007"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1649"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2174\/1381612825666190320135137"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.2165\/11597440-000000000-00000"},{"issue":"10","key":"e_1_2_6_7_1","first-page":"CD007482","article-title":"Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section","volume":"28","author":"Smaill FM","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-002028"},{"issue":"12","key":"e_1_2_6_9_1","first-page":"CD009516","article-title":"Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery","volume":"5","author":"Mackeen AD","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033013"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002863"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2009.05.003"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2016.08.005"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20137"},{"key":"e_1_2_6_16_1","unstructured":"European Committee on Antimicrobial Susceptibility Testing European society of clinical microbiology and infectious diseases. 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