Methods	RCT; 4 parallel groups.
	Unit of randomization: individual.
Participants	Dates of data collection: not reported.
	Setting: Letterman Army Medical Center, California; Womack Army Community Hospital, North Carolina
	Inclusion criteria: women in active labor or ruptured membranes and at least 1 digital vaginal examination (categorized as non-elective in this review although duration of membrane rupture not stated)
	Exclusion criteria: allergy to penicillin or cephalosporin, fever > 37.7°C with suspicion of chorioamnionitis; antibiotic use within 2 weeks
Interventions	Cefoxitin 2g IV after clamping the cord, repeated every 6 hours for 48 hours (N = 39) vs uterine and peritoneal lavage with 2 g cefoxitin after delivery of the placenta (N = 42) vs irrigation plus IV therapy (N = 38) vs no therapy (N = 39). The three treatment groups have been combined in this review
Outcomes	Febrile morbidity (> 37.9 °C twice 6 hours apart after first 24 hours); endometritis (fever and uterine tenderness); UTI (positive culture); wound infection (including fever, cellulitis and exudate); hospital stay (treatment 4.86 vs control 5.2; variance could not be calculated)
Notes	3 episodes of septicemia reported in control group vs none in treatment groups.
	No antibiotic reactions reported.
	Class of antibiotic: second generation cephalosporin (cefamycin)
	Subgroups: non-elective CS; after cord clamping.
Risk of bias
Item	Authors’ judgement	Description
Adequate sequence generation?	Yes	“Randomized… using a table of random numbers…”
Allocation concealment?	No	“Randomization into 1 of 4 groups was performed by using a table of random numbers,”
Blinding?	Unclear	Not placebo-controlled.
All outcomes		Clinician was not blinded.
Incomplete outcome data addressed?	Yes	No loss of participants to follow up.
All outcomes		No participant excluded form the analysis. ITT analysis.
Free of selective reporting?	Unclear	Insufficient information to judge.
Free of other bias?	Unclear	The 4 groups were comparable regarding age, parity, gestational age, rupture of membrane, labor, vaginal examination. Insufficient other information to judge
Overall low risk of bias?	Unclear	Mostly unclear.