Antimicrobial Utilization in Obstetric Care: A Narrative Review of Peripartum Antibiotic Use

Author

Shubhashree M S , Bilal K V , Ashwini Bhide M A , Syeda Zohra Batool , Vybhav U , Umesh M , Hanumanthachar Joshi

Abstract

  Background: Maternal infections remain an important concern in peripartum care, despite a 38% global decline since 1990. But excessive use of broad-spectrum and multiple antibiotics continues to contribute to antimicrobial resistance.

Objectives: To evaluate the global patterns of peripartum antibiotic utilization and assess evidence-based strategies for optimizing antibiotic prophylaxis and duration while maintaining maternal safety.

Methodology: A narrative review was conducted by synthesizing clinical evidence, relevant guidelines, and literature retrieved from , focusing on antibiotic use during peripartum care.

Results: Targeted antibiotic prophylaxis for non-elective caesarean deliveries was associated with reduced maternal infections, whereas routine antibiotic use in low-risk vaginal births showed no significant benefit. Evidence from quality-improvement interventions demonstrated that inappropriate antibiotic use could be reduced significantly without compromising clinical outcomes. Prolonged and indiscriminate broad-spectrum antibiotic use remains a major contributor to antimicrobial resistance.

Conclusions: Antibiotic use should be aligned with verified clinical risk and evidence-based indications to preserve antimicrobial efficacy without compromising maternal safety. Context-specific hospital policies, multidisciplinary collaboration, antimicrobial stewardship, and continuous staff feedback are essential for optimizing peripartum antibiotic use and improving maternal outcomes.

Keywords

Peripartum infection, Antibiotic utilization, Obstetric prophylaxis, Maternal sepsis, Antimicrobial stewardship

Full Text:

Download Paper PDF

References

1. Chen, L., Wang, Q., Gao, Y., Zhang, J., Cheng, S., Chen, H., ... & Cheng, J. (2021). The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019. BMC Infectious Diseases, 21(1), Article 1074. doi.org
2. Wang, S., Chen, S., Chen, M., Xu, W., Wu, Z., Hu, X., ... & Zhang, L. (2025). Global, regional and national burden of infections among pregnant women, 1990–2021: A prospective cohort study. BMJ Open, 15(6), Article e096746. doi.org
3. Hodoșan, V., Daina, C. M., Zaha, D. C., Daina, L., & Badau, D. (2022). Pattern of antibiotic use in the perinatal period in a public university hospital in Romania. Medicina, 58(6), Article 772. doi.org
4. Srinivasa, B., & Kotinatot, B. C. (2020). Drug utilization of antibiotics in post-operative cesarean section inpatients in tertiary care hospital: A prospective observational study. International Journal of Basic & Clinical Pharmacology, 9(6), 859–862. doi.org
5. Sharma, S., Kumari, N., Sengupta, R., Malhotra, Y., & Bhartia, S. (2021). Rationalising antibiotic use after low-risk vaginal deliveries in a hospital setting in India. BMJ Open Quality, 10(Suppl 1), Article e001413. doi.org
6. Van Schalkwyk, J., Van Eyk, N., Yudin, M. H., ... & Boucher, M. (2010). Antibiotic prophylaxis in obstetric procedures. Journal of Obstetrics and Gynaecology Canada, 32(9), 878–892. doi.org
7. American College of Obstetricians and Gynecologists. (2018). Antibiotic prophylaxis in labor and delivery(ACOG Practice Bulletin No. 195).
8. Ramasethu, J., & Kawakita, T. (2017). Antibiotic stewardship in perinatal and neonatal care. Seminars in Fetal and Neonatal Medicine, 22(6), 398–403. doi.org
9. Tita, A. T. N., Szychowski, J. M., Boggess, K., Saade, G., Longo, S., Clark, E., ... & Andrews, W. W. (2016). Adjunctive azithromycin prophylaxis for cesarean delivery. New England Journal of Medicine, 375(13), 1231–1241. doi.org
10. Sirilak, T., Kanjanarat, P., Nochaiwong, S., & Katip, W. (2022). Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth. Frontiers in Medicine, 9, Article 939421. doi.org
11. Ghia, C., & Rambhad, G. (2021). Disease burden due to Group B Streptococcus in the Indian population and the need for a vaccine – A narrative review. Therapeutic Advances in Infectious Disease, 8, 1–13. doi.org
12. Mackeen, A. D., Packard, R. E., Ota, E., & Speer, L. (2015). Antibiotic regimens for postpartum endometritis. Cochrane Database of Systematic Reviews, 2015(2), Article CD001067. doi.org
13. Axelsson, D., Brynhildsen, J., & Blomberg, M. (2023). Maternal obesity and the risk of postpartum infections according to mode of delivery. The Journal of Maternal-Fetal & Neonatal Medicine, 36(2), Article 2245102. doi.org
14. Servadio, M., Belleudi, V., Poggi, F. R., ... & Davoli, M. (2025). Real-world antibiotic utilization during pregnancy in Italy: A multiregional retrospective population-based study. BMC Pregnancy and Childbirth, 25(1), Article 7605. doi.org
15. Banerjee, A., & Biswas, J. (2025). Importance of hospital-specific antibiotic policy for ensuring maternal quality of care in India: A narrative review. Journal of Family Medicine and Primary Care, 14(1), 2133–2139. doi.org
16. Suzuki, D., Yamaji, N., Nishimura, E., ... & Ota, E. (2025). Effects of antibiotic prophylaxis during labour on maternal and neonatal outcomes in women planning vaginal birth. Cochrane Database of Systematic Reviews, 2025(2), Article CD016211. doi.org
17. Moradi, M., Grieger, J. A., Teong, X. T., & Heilbronn, L. (2026). Intrapartum antibiotic prophylaxis and child health outcomes: A systematic review and meta-analysis of observational studies. BJOG: An International Journal of Obstetrics & Gynaecology, 133(1), 70015. doi.org
18. Lissauer, D., Morgan, M., Banerjee, A., Plaat, F., & Pasupathy, D. (2025). Identification and management of maternal sepsis during and following pregnancy: Green-top Guideline No. 64. BJOG: An International Journal of Obstetrics & Gynaecology, 132(4), 18009. doi.org
19. Robinson, M. L., Johnson, J., Naik, S., ... & Gupta, A. (2023). Maternal colonization versus nosocomial transmission as the source of drug-resistant bloodstream infection in an Indian neonatal intensive care unit: A prospective cohort study. Clinical Infectious Diseases, 77(3), 282–290. doi.org
20. Winteler, C., Ardabili, S., Hodel, M., & Stocker, M. (2025). A systematic review of perinatal antibiotic stewardship – Where we are, where to go? Journal of Perinatology, 45(1), 2209–2218. doi.org