In cesarean delivery, when should perioperative antibiotics be administered?

• A. After skin incision
• B. During labor after rupture of membranes
• C. At the time of anesthesia induction
• D. Within 60 minutes prior to making the initial incision

Answer: (D)

Prophylactic perioperative antibiotics for cesarean delivery are given to ensure adequate tissue levels at the moment the incision is made, so any bacteria entering the wound are exposed to the antibiotic from the start. Administering the drug within 60 minutes before the initial skin incision achieves peak tissue concentrations right at the time of incision, maximizing protection against surgical site infection. If the antibiotic is given after the incision, the wound is already exposed to potential contamination before effective levels are present, reducing its protective effect. Giving antibiotics during labor after rupture of membranes or at anesthesia induction can still be useful, but the precise, tested window is within 60 minutes prior to the incision. Therefore, the best timing is within 60 minutes prior to making the initial incision.