Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.
BACKGROUND
Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries.


OBJECTIVE
To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2009).


METHODS
We included randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity.


METHODS
We independently assessed eligibility and quality of the studies.


RESULTS
Four trials (involving 1361 randomized and 1198 analyzed women) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 9.4% in control groups to 5.2% in vaginal cleansing groups (risk ratio (RR) 0.57, 95% confidence interval (CI) 0.38 to 0.87, four trials, 1198 women). The risk reduction was particularly strong for women with ruptured membranes (1.4% in the vaginal cleansing group versus 15.4% in the control group; RR 0.13, 95% CI 0.02 to 0.66, two trials, 148 women). No other outcomes realized statistically significant differences between the vaginal cleansing and control groups. No adverse effects were reported with the povidone-iodine vaginal cleansing.


CONCLUSIONS
Vaginal preparation with povidone-iodine solution immediately before cesarean delivery reduces the risk of postoperative endometritis. This benefit is particularly realized for women undergoing cesarean delivery with ruptured membranes. As a simple, generally inexpensive intervention, providers should consider implementing preoperative vaginal cleansing with povidone-iodine before performing cesarean deliveries.
Department of Obstetrics and Gynecology, Indiana University School of Medicine, 1001 West 10th Street, F-5, Indianapolis, Indiana, USA, IN 46202.
David M
DM
Haas
Sarah
S
Morgan Al Darei
Karenrose
K
Contreras
D000282:Administration, Intravaginal; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002585:Cesarean Section / Q000009:adverse effects*; D004203:Disinfection / Q000379:methods*; D004716:Endometritis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011247:Pregnancy; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014621:Vagina
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine