Antibiotic prophylaxis after operative vaginal birth: the ANODE randomized controlled trial

© 2020 All forms of operative birth are associated with a higher risk of infection compared to unassisted vaginal birth. Evidence of benefit of antibiotic prophylaxis at caesarean birth is well established, but prior to the ANODE trial, evidence of effectiveness of antibiotic prophylaxis after assisted vaginal birth was lacking. The ANODE trial randomized 3427 women to a single intravenous dose of co-amoxiclav or placebo immediately after assisted vaginal birth and showed an almost halving of the rate of confirmed or suspected infection, from 19% in the antibiotic group to 11% in the placebo group. Royal College of Obstetricians and Gynaecologists guidance has now been changed to recommend routine use of a single dose prophylactic antibiotic after operative vaginal birth on the basis of this clear evidence of benefit.