Antibiotic prophylaxis is recommended for all cesarean deliveries unless the patient is already receiving an antibiotic regimen with equivalent broad-spectrum coverage, according to new clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG). The updated practice bulletin reflects a limited change to clarify and provide additional information on recommendations from recent consensus guidelines for antimicrobial prophylaxis in surgery and the prevention of surgical site infections (SSIs). Among the (Level A) recommendations and conclusions:

• Antibiotic prophylaxis is recommended for all cesarean deliveries unless the patient is already receiving an antibiotic regimen with equivalent broad-spectrum coverage (eg, for chorioamnionitis), and such prophylaxis should be administered within 60 minutes before the start of the cesarean delivery.
• For cesarean delivery prophylaxis, a single dose of a targeted antibiotic, such as a first-generation cephalosporin, is the first-line antibiotic of choice, unless significant drug allergies are present.
• The addition of azithromycin, infused over 1 hour, to a standard antibiotic prophylaxis regimen may be considered for women undergoing a nonelective cesarean delivery.
• Vaginal cleansing before cesarean delivery in laboring patients and those with ruptured membranes using either povidine–iodine or chlorhexidine gluconate may be considered.
• Preoperative skin cleansing before cesarean delivery with an alcohol-based solution should be performed unless contraindicated.
• For patients with prelabor rupture of membranes (PROM) at < 34 0/7 weeks of gestation, antibiotic prophylaxis is indicated to prolong the latency period between membrane rupture and delivery.
• Antibiotic prophylaxis should not be used for pregnancy prolongation in women with preterm labor and intact membranes.