title: Preoperative vaginal preparation with povidone-iodine and the risk of postcesarean endometritis.
abstract: OBJECTIVE
  Postcesarean endometritis and wound infection remain significant morbidities, despite use of strategies to prevent these complications. We investigated the effect of preoperative vaginal preparation with povidone-iodine as a preventive intervention against postcesarean endometritis and wound infection.
  
  
  METHODS
  A randomized controlled study was performed in 308 women undergoing nonemergent cesarean delivery. Subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotic at the time of umbilical cord clamping. Each subject's postoperative course was reviewed for development of febrile morbidity (temperature > 38.0 degrees C), endometritis (temperature > 38.4 degrees C accompanied by fundal tenderness occurring beyond the first postoperative day, in the absence of evidence of other infection), and wound infection.
  
  
  RESULTS
  Postcesarean endometritis occurred in 7.0% of subjects who received a preoperative vaginal preparation and 14.5% of controls (P < .05). There was no measurable effect of a vaginal scrub on the development of postoperative fever or wound infection. The adjusted odds ratio for developing endometritis after a vaginal preparation was 0.44 (95% confidence interval [CI] 0.193-0.997). Multivariate analysis showed an increased risk of developing endometritis in association with severe anemia (adjusted OR 4.26, 95% CI 1.568-11.582), use of intrapartum internal monitors (adjusted OR 2.84, 95% CI 1.311-6.136), or history of antenatal genitourinary infection (adjusted OR 2.9, 95% CI 1.265-6.596).
  
  
  CONCLUSIONS
  Preoperative vaginal scrub with povidone-iodine decreases the incidence of postcesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection.
authors.affiliation: Department of Obstetrics and Gynecology, Chicago Lying-In Hospital, University of Chicago Hospitals, Chicago, Illinois, USA. rvagbunag@hotmail.com
authors.forename: Rosally V
authors.initials: RV
authors.lastname: Starr
authors.forename: Jill
authors.initials: J
authors.lastname: Zurawski
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ismail
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000009:adverse effects* / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures; D004716:Endometritis / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D015999:Multivariate Analysis; D011206:Povidone-Iodine / Q000009:adverse effects* / Q000627:therapeutic use; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine