Introduction
Maternal infection following delivery of a foetus can result in life-threatening complications such as sepsis. This accounts for 7% of maternal deaths in the UK post-partum1. Treatment of serious complications such as sepsis places a large financial burden on the NHS, with all sepsis treatment reported to cost the NHS £2.5 billion annually2.
Key determinants of maternal sepsis include interventional deliveries such as caesarean section and operative vaginal delivery, with infection occurring in approximately 20% and 16% of cases respectively1. Caesarean section involves an abdominal incision to deliver the foetus. Operative vaginal delivery – occurring in approximately 13% of pregnancies – involves the delivery of the foetus through the vagina using forceps or ventouse (vacuum)1. For the former, antibiotic prophylaxis is recommended as the gold-standard practice by NICE (National Institute of Clinical Excellence)3, with evidence reporting up to a 70% decrease in wound infection and severe maternal infection1. On the other hand, recommendation for prophylactic antibiotics to be given for operative vaginal delivery was only given in 2020 by the Royal College of Obstetricians and Gynaecologists4 in response to the results of the ANODE trial.
This paper is an economic evaluation based on data obtained from the ANODE trial1. The objective of the evaluation is to compare the costs and benefits yielded by a single dose of co-amoxiclav with that of a placebo following operative vaginal delivery over a 6-week time horizon. This will inform whether in addition to being an efficacious practice, it is a cost effective one too.