From the Guidelines
Cesarean delivery is not indicated for chlamydia infection in labor. Women with active chlamydia infection can safely deliver vaginally. If chlamydia is diagnosed during labor, treatment should be initiated with azithromycin 1 gram orally as a single dose, as recommended by the Centers for Disease Control and Prevention 1. This antibiotic is safe in pregnancy and during breastfeeding. The newborn should be monitored for potential complications such as conjunctivitis or pneumonia, but these risks do not warrant cesarean delivery. Vertical transmission of chlamydia can occur during vaginal birth, but the risk is reduced with proper antibiotic treatment, and the potential complications in the newborn are generally treatable, as noted in the guidelines for the prevention and management of chlamydia trachomatis infections 1. The risks associated with cesarean delivery, such as surgical complications, increased bleeding, longer recovery time, and complications in future pregnancies, outweigh any theoretical benefit of preventing chlamydia transmission. Standard eye prophylaxis given to all newborns also helps prevent chlamydial conjunctivitis. Treatment of sexual partners is also important to prevent reinfection. Key considerations include:
- The risk of vertical transmission of chlamydia during vaginal birth is significant, with nearly two-thirds of infants born vaginally to mothers with chlamydial infection becoming infected during delivery 1
- The potential complications in the newborn, such as conjunctivitis and pneumonia, are generally treatable with antibiotics
- The benefits of vaginal delivery, including reduced risk of surgical complications and shorter recovery time, outweigh the risks associated with chlamydia transmission.
From the Research
Chlamydia Infection in Labor and Cesarean Indication
- There is no direct evidence to suggest that cesarean delivery is indicated for chlamydia infection in labor 2, 3, 4, 5.
- Studies have focused on the treatment of chlamydia infection during pregnancy, with azithromycin being a recommended single-dose therapy 2, 3, 5.
- Chlamydia infection can be transmitted to infants during delivery, regardless of the delivery method, including cesarean section 4.
- The decision to perform a cesarean delivery is typically based on other maternal and obstetrical indications, such as labor dystocia, multifetal pregnancy, and malpresentation 6.
- Chlamydia infection itself is not listed as a common indication for primary cesarean delivery 6.