title: Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.
abstract: 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 (21 July 2014).
  
  
  METHODS
  We included randomized and quasi-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
  Five trials randomizing 1946 women (1766 analyzed) 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 7.2% in control groups to 3.6% in vaginal cleansing groups (average risk ratio (RR) 0.39, 95% confidence interval (CI) 0.16 to 0.97, five trials, 1766 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.The quality of the evidence using GRADE was low for post-cesarean endometritis, moderate for postoperative fever, and low for wound infection.
  
  
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, 1001 West 10th Street, F-5, Indianapolis, Indiana, USA, IN 46202.
authors.forename: David M
authors.initials: DM
authors.lastname: Haas
authors.forename: Sarah
authors.initials: S
authors.lastname: Morgan
authors.forename: Karenrose
authors.initials: K
authors.lastname: Contreras
mesh_terms: 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; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014621:Vagina
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine