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B YT NG IH CD C HẨ N I NGUY N VI T H NG TRI N KHAI CHUY N I KHỄNG SINH T NG TIểM SANG NG U NG TRểN B NH NHỂN SAU M L Y THAI T I B NH VI N A KHOA C GIANG KHịA LU N T T NGHI P D HẨ N I ậ 2022 CS Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC TR B YT NG IH CD C HẨ N I NGUY N VI T H NG Mã sinh viên: 1701237 TRI N KHAI CHUY N I KHỄNG SINH T NG TIểM SANG NG U NG TRểN B NH NHỂN SAU M L Y THAI T I B NH VI N A KHOA C GIANG KHịA LU N T T NGHI P D Ng CS i h ng d n: ThS Nguy n Mai Hoa ThS Nguy n Thu H ng N i th c hi n: Trung tơm DI&ADR Qu c gia B nh vi n a khoa c Giang HẨ N I ậ 2022 Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC TR L IC M N u tiên, xin g i l i c m n chơn thƠnh nh t t i ThS Nguy n Thu H ng ậ Phó tr ng khoa D c, B nh vi n a khoa c Giang, ThS Nguy n Mai Hoa ậ chuyên viên Trung tâm DI&ADR Qu c gia đư h ng d n, sát vƠ đ ng viên trình hồn thành khóa lu n nƠy, c ng nh t o u ki n đ giúp tri n khai nghiên ng khoa S n, B nh vi n a khoa c Giang toàn th bác s , u d ng t i khoa đư t o u ki n cho ti n hành nghiên c u nhi t tình giúp đ , h ng d n th i gian nghiên c u Tơi xin đ c bày t lịng bi t n sơu s c t i PGS TS Nguy n Hoàng Anh ậ Giám đ c Trung tâm DI&ADR Qu c gia, gi ng viên cao c p b môn D c l c, Tr ng i h c D c Hà N i, ng i đư dƠnh nhi u th i gian tâm huy t đ nh h ng, d n d t t nh ng ngƠy đ u làm nghiên c u Th y đư cho tơi nhi u l i khun b ích h c quý giá v t vƠ đ o đ c c a ng i làm nghiên c u khoa h c Xin đ c g i l i c m n t i Ds Nguy n Hoàng Anh, ThS ng Th Thanh Huy n anh ch chuyên viên Trung tâm DI&ADR Qu c gia anh ch d c s khoa D c, B nh vi n a khoa c Giang đư h t lịng giúp đ , ch b o tơi t nh ng u nh bé nh t, giúp tích l y thêm nh ng kinh nghi m h u ích q trình th c hi n nghiên c u Tôi c ng xin trơn tr ng c m n Ban giám đ c B nh vi n phòng K ho ch t ng h p phòng B nh án, B nh vi n a khoa ki n cho th c hi n đ tài nghiên c u a khoa c Giang, c Giang đư t o u Tôi xin g i l i tri ơn đ n th y cô giáo tr ng i h c D c Hà N i đư giúp đ tơi tích l y thêm nhi u ki n th c n n t ng quỦ báu, gia đình vƠ b n bè c a đư bên c nh, yêu th ng vƠ ng h tôi, lƠ m t a v ng ch c đ v đ đ n đ c ngày hôm t qua m i th thách Hà N i, ngày 26 tháng n m 2022 SINH VIÊN Nguy n Vi t H ng Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC c u t i b nh vi n Tôi xin trân tr ng c m n BSCKII Nguy n Thùy Trang ậ Tr M CL C DANH M C CÁC KÝ HI U VI T T T DANH M C B NG DANH M C HÌNH TV N Ch ng T NG QUAN 1.1.1 Khái ni m nhi m khu n v t m 1.1.2 Th c tr ng nhi m khu n v t m m l y thai 1.1.3 Tác nhân gây nhi m khu n v t m m l y thai 1.1.4 Y u t nguy c nhi m khu n v t m ph u thu t m l y thai .4 1.1.5 ánh giá nguy c nhi m khu n v t m 1.1.6 Bi n ch ng c a nhi m khu n v t m sau m l y thai 1.1.7 Các bi n pháp d phòng nhi m khu n v t m .10 1.2 T ng quan v kháng sinh d phòng m l y thai 11 1.2.1 Khái ni m nguyên t c s d ng kháng sinh d phòng 11 1.2.2 Hi u qu c a kháng sinh d phòng ph u thu t m l y thai 11 1.2.3 L a ch n kháng sinh d phòng m l y thai 11 1.2.4 Th i m đ a li u kháng sinh d phòng m l y thai 13 1.2.5 Th i gian s d ng kháng sinh d phòng m l y thai 13 1.2.6 Th c tr ng thách th c s d ng kháng sinh d phòng m l y thai 14 1.3 Tri n khai chuy n đ i đ ng dùng kháng sinh d phòng ch ng trình qu n lý kháng sinh 16 1.3.1 Vai trò c a can thi p kháng sinh d phòng 16 1.3.2 Các chi n l c can thi p kháng sinh d phòng 18 1.4 Tri n khai chuy n đ i đ ng dùng kháng sinh t đ ng tiêm sang đ ng u ng 19 1.4.1 L i ích c a chuy n đ i đ ng dùng kháng sính 19 1.4.2 Nguyên t c chuy n đ i đ ng dùng kháng sinh 19 1.4.3 M t s nghiên c u v chuy n đ i đ ng dùng kháng sinh d phòng 21 1.5 Vài nét v khoa S n, B nh vi n a khoa Ch 2.1 ng it IT NG VẨ PH c Giang 21 NG PHỄP NGHIểN C U 23 ng nghiên c u 25 Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC 1.1 T ng quan v nhi m khu n v t m ph u thu t m l y thai 2.1.1 i t ng nghiên c u đ xây d ng phác đ chuy n đ i đ ng dùng kháng sinh d phòng ph u thu t m l y thai t i khoa S n, B nh vi n a khoa c Giang .25 2.1.2 i t ng nghiên c u đ phơn tích, đánh giá hi u qu c a phác đ chuy n đ i đ ng dùng kháng sinh d phòng ph u thu t m l y thai t i khoa S n, B nh vi n a khoa c Giang 26 ng pháp nghiên c u 27 2.2.1 Ph ng pháp nghiên c u đ xây d ng phác đ chuy n đ i đ ng dùng kháng sinh d phòng ph u thu t m l y thai t i khoa S n, B nh vi n a khoa c Giang .27 2.2.2 Ph ng pháp nghiên c u đ phân tích hi u qu an toàn c a phác đ chuy n đ i đ ng dùng kháng sinh d phòng ph u thu t m l y thai t i khoa S n, B nh vi n a khoa c Giang .29 2.3 K thu t x lý phân tích s li u 31 Ch ng K T QU NGHIÊN C U 33 3.1 K t qu xây d ng phác đ chuy n đ i đ ng dùng kháng sinh d phòng t đ ng tiêm sang đ ng u ng m l y thai t i khoa S n, B nh vi n a khoa c Giang 33 3.1.1 T ng quan tài li u 33 3.1.2 Kh o sát đ c m s d ng KSDP m l y thai t i khoa S n 44 3.1.3 Quy trình chuy n đ i đ ng dùng kháng sinh d phòng đ i t ng s n ph m l y thai t i khoa S n, B nh vi n a khoa c Giang .48 3.2 K t qu phân tích hi u qu c a ch ng trình chuy n đ i đ ng dùng kháng sinh d phòng t đ ng tiêm sang đ ng u ng s n ph m l y thai t i khoa S n, B nh vi n a khoa c Giang 51 3.2.1 c m chung ti n s s n khoa sau ghép c p .53 3.2.2 c m ph u thu t m l y thai sau ghép c p 53 3.2.3 c m s d ng kháng sinh sau ghép c p 54 3.2.4 Hi u qu d phòng NKVM kh n ng ti t ki m chi phí c a ch ng trình chuy n đ i đ ng dùng kháng sinh d phòng 56 Ch ng BẨN LU N 59 4.1 Bàn lu n v xây d ng phác đ chuy n đ i đ ng dùng kháng sinh d phòng ph u thu t m l y thai t i khoa S n, B nh vi n a khoa c Giang 60 4.1.1 T ng quan tài li u y u t nguy c ph u thu t m l y thai 60 4.1.2 c m s d ng kháng sinh c a s n ph 62 4.1.3 Quy trình KSDP đ i t ng s n ph ph u thu t m l y thai 62 Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC 2.2 Ph 4.2 Bàn lu n v phân tích hi u qu an toàn c a phác đ chuy n đ i đ ng dùng kháng sinh d phòng ph u thu t m l y thai t i khoa S n, B nh vi n a khoa c Giang 67 4.2.1 c m b nh nhơn vƠ đ c m ph u thu t hai nhóm 68 4.2.2 Hi u qu s d ng kháng sinh d phòng .68 u m h n ch c a nghiên c u 71 4.3 M t s 4.3.1 u m 71 K T LU N 74 KI N NGH 76 TÀI LI U THAM KH O PH L C TIÊU CHU N CH N OỄN NHI M KHU N V T M PH L C CHI N L C VÀ K T QU TÌM KI M TÀI LI U V Y U T NGUY C NHI M KHU N V T M TRONG M L Y THAI PH L C M U PHI U SÀNG L C B NH NHÂN PH L C QUY TRÌNH K PH L C PH L C KHÁNG SINH D PHÒNG CHO M L Y THAI M U PHI U THU TH P D LI U PHI U PH NG V N B NH NHÂN THU T CHUY N I NG DÙNG PH L C C I M B NH NHÂN VÀ C I M PH U THU T C A NHÓM NGHIÊN C U M C TIểU TR C GHÉP C P PH L C PH L C CỄC TR NG H P X Y RA BI N C NGÀY THEO DÕI SAU PH U THU T K T QU PHÂN TÍCH CÁC Y U T PH L C 10 PH L C 11 PH L C 12 NGUY C G P NHI M KHU N V T M NHÓM TI N C U GIÁ THÀNH C A KHÁNG SINH VÀ V T T Y T I KỆM DANH SÁCH B NH NHÂN TRONG NGHIÊN C U DANH M C KHÁNG SINH CHUY N T NG TIÊM/TRUY N SANG B T L I TRONG 42 NHÓM TI N C U NH H NG N NG U NG (IV/PO) Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC 4.3.2 H n ch 72 DANH M C CÁC KÝ HI U VI T T T ACS ACOG Hi p h i Ph u thu t viên Hoa K (American College of Surgeons) Hi p h i S n Ph khoa Hoa K (the American College of Obstetricians APSIC and Gynecologists) Hi p h i Ki m soát Nhi m khu n chơu Ễ Thái Bình D ASA Society of Infection Control ) Hi p h i Gây mê Hoa K (American Society of Anesthesiologists) BMI Hi p h i D c s B nh vi n Hoa K (American Society of Health System Pharmacists) Ch s kh i c th (Body mass index) CDC Trung tâm Ki m soát Phòng ng a B nh t t Hoa K (Center for Disease CPSI Control and Prevention) Vi n an toàn b nh nhân Canada (Canadian Patient Safety Institute) ASHP KSDP Trung tâm Ki m sốt Phịng ng a B nh t t Châu Âu (European Center for Disease Prevention and Control) Kháng sinh d phòng MIC MLT N ng đ c ch t i thi u (Minimum inhibitory concentration) M l y thai WNHS T ch c ch m sóc s c kh e ph n tr s sinh Tơy Nam Australia (Westerm Australia North Metropolitan Health Service, Woman and ECDC NHSN Newborn Health Service) M ng l i ch m sóc s c kh e an toàn Hoa K (National Healthcare Safety Network) NICE Vi n ch m sóc s c kh e V and Care Excellence) ng qu c Anh (National Institute for Health NKVM NNIS Nhi m khu n v t m H th ng Giám sát Qu c gia v Nhi m khu n b nh vi n Hoa K (National Nosocomial Infections Surveillance System) RCT Th nghi m lâm sàng ng u nhiên có đ i ch ng (Randomized controlled SHC trial) Ch m sóc s c kh e Stanford (Stanford health care) SFAR Hi p h i gơy tê vƠ ch m sóc tích c c Pháp (the French society of Anaesthesia and Intensive Care Medicine) SKD SHEA Sinh kh d ng M ng l i d ch t ch m sóc s c kh e Hoa K (the Society for Healthcare Epidemiology of America) Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC ng (Asia Pacific SIGN M ng l ng d n Liên tr SIS Guidelines Network) Hi p h i nhi m trùng Ngo i khoa Hoa K (Surgical Infection Society) WHO YTNC T ch c Y t Th gi i Y u t nguy c ng môn Scotland (Scottish Intercollegiate Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC iH Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC DANH M C B NG B ng 1.1 Thang m ASA đánh giá tình tr ng b nh nhơn tr c ph u thu t B ng 1.2 Phân lo i ph u thu t theo CDC B ng 1.3 Ch s nguy c nhi m khu n v t m NNIS .9 B ng 1.4 L c đ phân t ng nguy c g p nhi m khu n v t m m l y thai B ng 1.5 Các bi n pháp phòng ng a nhi m khu n v t m 10 B ng 1.6 i u ki n chuy n đ i đ ng dùng kháng sinh 20 B ng 3.1 T ng h p y u t nguy c nhi m khu n v t m sau m l y thai t nghiên c u .33 B ng 3.2 c m m t s y u t nguy c quan tr ng c a nhi m khu n v t m sau m l y thai 36 B ng 3.3 T ng h p y u t nguy c nhi m khu n v t m t h ng d n .41 B ng 3.4 T ng h p y u t nguy c nhi m khu n v t m sau m l y thai t h ng d n .43 B ng 3.5 c m chung ti n s s n khoa c a s n ph nhóm kh o sát 45 B ng 3.6 c m ph u thu t m l y thai nhóm kh o sát 46 B ng 3.7 c m s d ng kháng sinh đ t m l y thai nhóm kh o sát .47 B ng 3.8 c m s d ng KSDP đ t m l y thai nhóm kh o sát 47 B ng 3.9 T l s n ph đ c đ a vƠo ch ng trình chuy n đ i đ ng dùng KSDP 51 B ng 3.10 c m chung ti n s s n khoa c a m u nghiên c u 53 B ng 3.11 c m ph u thu t m l y thai sau ghép c p 54 B ng 3.12 c m s d ng kháng sinh sau ghép c p 55 B ng 3.13 Th i gian s d ng kháng sinh sau ghép c p 55 B ng 3.14 Hi u qu d phòng nhi m khu n v t m .56 B ng 3.15 Tình tr ng b nh nhân sau chuy n đ i đ ng dùng KSDP 57 B ng 3.16 Kh n ng ti t ki m chi phí c a ch ng trình chuy n đ i đ ng dùng KSDP .58 Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC DANH M C HÌNH Hình 1.1 Phân lo i nhi m khu n v t m Hình 2.1 S đ thi t k nghiên c u .24 Hình 2.2 S đ xây d ng phác đ chuy n đ i đ ng dùng KSDP .27 Hình 3.1 S đ sàng l c b nh nhân kh o sát đ c m s d ng kháng sinh 45 Hình 3.2 Th i gian s d ng kháng sinh đ t m l y thai nhóm kh o sát .48 Hình 3.3 Quy trình chuy n đ i đ ng dùng kháng sinh d phòng .50 Hình 3.4 Quy trình l a ch n m u nghiên c u m c tiêu 52 KI N NGH T k t qu c a nghiên c u, có m t s ki n ngh nh sau: - T ng c ng ho t đ ng vai trò c a d c s lơm sƠng đ tri n khai ch ng trình chuy n đ i đ ng dùng KSDP h p lý b n v ng - Ti p t c th c hi n giám sát, đánh giá th ng xuyên hi u qu c a ch ng trình x trí k p th i hi u qu - Ti p t c áp d ng m r ng th ng quy ch ng trình chuy n đ i đ KSDP nh ng b nh nhơn đ tiêu chu n t i khoa S n ng dùng - M r ng ch ng trình KSDP t i khoa Ngo i khác B nh vi n d a kinh nghi m tri n khai t i khoa S n 76 Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC KSDP t i khoa S n, B nh vi n a khoa c Giang - D c s lơm sƠng giám sát ch t ch vi c tuân th quy trình, t có bi n pháp Tài li u ti ng Vi t B Y t , H ng d n phòng ng a nhi m khu n v t m Ban hành kèm theo Quy t đ nh s : Q 3671/BYT 2012 B Y t , H ng d n s d ng kháng sinh Ban hành kèm theo Quy t đ nh s : Q 708/BYT 2015 B Y t , H ng d n th c hi n qu n lý kháng sinh t i b nh vi n Ban hành kèm theo Quy t đ nh s : Q 772/BYT 2016 B Y t , H ng d n th c hi n qu n lý s d ng kháng sinh b nh vi n Ban hành kèm theo Quy t đ nh s : Q 5631/BYT 2020 Nguy n Th Thu Giang (2014), "B c đ u đánh giá hi u qu c a kháng sinh d phòng cefuroxim ph u thu t c t s ng t i khoa Ngo i B nh vi n i h c Y Hà N i", Y h c TP H Chí Minh, 18(6), pp 91-95 Lê Th Thu Hà (2018), "Ch ng vi khu n th ng g p nhi m khu n v t m c t cung sau m l y thai t i B nh vi n T D ", Nghiên c u Y h c, 22(1), pp 118-122 Lê Th Thu Hà (2019), "Ch ng vi khu n th ng g p nhi m khu n v t m nông sâu sau m l y thai t i B nh vi n T D ", Nghiên c u Y h c, 23(2), pp 154-158 Lê Th Thu Hà (2019), "T l y u t liên quan c a nhi m khu n v t m sau m l y thai t i B nh vi n T D ", Y h c TP H Chí Minh, 2(2), pp 147-153 H ng H nh (2016), "Kh o sát tình tr ng nhi m khu n tình hình kháng kháng sinh t m u b nh ph m nuôi c y t i khoa Vi Sinh B nh Vi n a Khoa c Giang t Tháng 1/2015 đ n tháng 6/2016", pp 10 Nguy n Vi t Hùng (2010), " c m d ch t h c nhi m khu n v t m tình hình s d ng kháng sinh b nh nhân ph u thu t t i m t s b nh vi n t nh phía B c 2008", Y h c th c hành, 750(2), pp 48-52 11 Nguy n Th Thu H ng (2012), Tri n khai thí m ch ng trình kháng sinh d phòng c t túi m t n i soi t i B nh vi n i h c Y Hà N i, Lu n v n th c s D c h c, i h c D c Hà N i 12 Hà Nguy n Y Khuê (2019), " ánh giá hi u qu c a vi c chuy n đ i kháng sinh t đ ng tiêm sang đ ng u ng t i B nh vi n i h c Y d c thành ph H Chí Minh/Hà Nguy n Y Khuê", Y h c TP H Chí Minh, 23(2), pp 170-177 13 Nguy n Th Linh (2015), Phân tích tình hình s d ng kháng sinh b nh nhân ph u thu t t i B nh vi n a khoa c Giang, Lu n v n th c s D c h c, i h c D c Hà N i 14 Nguy n Thanh L ng (2019), Tri n khai thí m ch ng trình kháng sinh d phịng t i khoa ph u thu t l ng ng c, B nh vi n B ch Mai, Khóa lu n t t nghi p D c s , i h c D c Hà N i 15 Võ H u Ngoan (2017), "Nhi m khu n v t m s d ng kháng sinh d phòng t i B nh vi n Ch R y ", Y h c TP H Chí Minh, 21(3), pp 67-71 16 Bùi H ng Ng c (2018), " ánh giá hi u qu ch ng trình qu n lý kháng sinh s d ng kháng sinh d phòng t i khoa Ngo i - B nh vi n Bình Dân", Y h c TP H Chí Minh, 22(1), pp 148-154 17 oƠn Mai Ph ng, Nguy n Vi t Hùng (2009), " c m d ch t h c nhi m khu n v t m tình hình s d ng kháng sinh b nh nhân ph u thu t t i m t s b nh vi n t nh phía b c ", Di n đàn Y h c, 7(42), pp 64-69 Trung tâm DI&ADR Qu c gia - tài li u chia s t i CANHGIACDUOC.ORG.VN facebook CANHGIACDUOC TÀI LI U THAM KH O Hoàng Th Thu H ng (2018), Tri n khai ch ng trình kháng sinh d phịng m l y thai t i B nh vi n a khoa Trung ng Thái Nguyên, Lu n v n D c s chuyên khoa c p II, i h c D c Hà N i 19 Lê Th Mai Ph ng (2019), ánh giá ho t đ ng c a d c s lâm sàng h ng đ n s d ng kháng sinh h p lý t i khoa Ch n th ng ch nh hình B nh vi n a khoa c Giang, Lu n v n th c s D c h c, i h c D c Hà N i 20 Tr n Vi t Tân (2019), "Các y u t liên quan đ n nhi m khu n sau m l y thai t i B nh vi n T D ", Y h c TP H Chí Minh, 23(2), pp 170-176 21 Ph m H ng Th m (2017), " ánh giá hi u qu chuy n đ i đ ng dùng kháng sinh b nh nhân t i khoa Ch n th ng ch nh hình", Y h c TP H Chí Minh, 21(6), pp 22 Ph m H ng Th m (2018), " ánh giá hi u qu chi phí chuy n đ i s m đ ng dùng kháng sinh t i B nh vi n Nhơn dơn Gia nh", Y h c TP H Chí Minh, 22(6), pp 208-215 23 Nguy n Th Kim Thu, Nguy n Th H ng Ly (2021), " ánh giá tình tr ng nhi m khu n v t m l y thai t i Khoa S n, B nh vi n Trung ng Quơn đ i 108", Journal of 108-Clinical Medicine and Phamarcy, pp 24 Lê Th Anh Th (2011), "Nh ng rào c n áp d ng h ng d n s d ng kháng sinh b nh nhân ngo i khoa t i B nh vi n Ch R y", Y h c TP H Chí Minh, 15(2), pp 38-43 25 Hu nh Th Thu Th y (2011), ánh giá hi u qu chuy n đ i kháng sinh t đ ng tiêm t nh m ch sang đ ng u ng b nh nhân sau m l y thai t i B nh vi n T D , Tp H Chí Minh, báo cáo tài khoa h c, B nh vi n T D 26 Nguy n V n Tr ng, Nguy n Th Thanh Minh, et al (2009), "Nhi m khu n v t m sau m c t t cung t i B nh vi n Hùng V ng, Tp H Chí Minh", Th i s Y h c, 38, pp 7-12 Tài li u ti ng Anh 27 Abdel Jalil Mariam Hantash, Abu Hammour Khawla, et al (2017), "Surgical site infections following caesarean operations at a Jordanian teaching hospital: frequency and implicated factors", Scientific reports, 7(1), pp 1-9 28 Abubakar Usman, Syed Sulaiman Syed Azhar, et al (2019), "Impact of pharmacist-led antibiotic stewardship interventions on compliance with surgical antibiotic prophylaxis in obstetric and gynecologic surgeries in Nigeria", PloS one, 14(3), pp e0213395 29 Alrammaal Hanadi H, Abduljalil Khaled, et al (2022), "Application of a physiologically based pharmacokinetic model to predict cefazolin and cefuroxime disposition in obese pregnant women undergoing caesarean section", Pharmaceutics, 14(6), pp 1162 30 Alrammaal Hanadi H, Batchelor Hannah K, et al (2021), "Prophylactic perioperative cefuroxime levels in plasma and adipose tissue at the time of caesarean section (C-LACE): a protocol for a pilot experimental, prospective study with non-probability sampling to determine interpatient variability", Pilot and feasibility studies, 7(1), pp 1-8 31 Alrammaal Hanadi H, Batchelor Hannah K, et al (2019), "Efficacy of perioperative cefuroxime as a prophylactic antibiotic in women requiring caesarean section: a systematic review", European Journal of Obstetrics & Gynecology and Reproductive Biology, 242, pp 71-78 Trung tâm DI&ADR Qu c gia - 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