BACKGROUND AND PURPOSE:

• Cesarean section is associated with a 5-20 fold increase in maternal infection related complications
  • Primarily ascending anaerobic bacteria
• Cochrane review demonstrated (based on low quality evidence) that vaginal cleansing may reduce infection risk
• Caissutti et al. (Obstet Gynecol, 2017) assessed whether vaginal cleansing before cesarean delivery reduced rates of postoperative endometritis

METHODS:

• Systematic review and meta-analysis
• Selection criteria included all randomized controlled trials (RCTs) comparing vaginal cleansing (any type) with a control group in women undergoing cesarean
• Primary outcome
  • Incidence of endometritis
• Secondary outcomes
  • Postoperative wound infection
  • Postoperative fever greater than 38°C or 100.4°F
  • Other wound complications (e.g. postoperative wound seroma or hematoma)

RESULTS:

• Pooled 4,837 women from 16 trials on vaginal cleansing immediately before cesarean section
• 4,744 women were involved in 15 RCTs, where they were randomized to vaginal cleansing or control (placebo or no treatment)
  • I trial analyzed separately as it compared povidone-iodine with chlorhexidine
• In 11 RCTs povidone-iodine used (ranging from 1% to 10%), most commonly using a sponge stick for 30 seconds
• When comparing vaginal cleansing to controls, there was
  • Lower incidence of endometritis (4.5% vs 8.8%; relative risk [RR] 0.52, 95% CI 0.37-0.72)
  • Postoperative fever (9.4% vs 14.9%; RR 0.65, 95% CI 0.50-0.86)
• Reduction in the incidence of endometritis with vaginal cleansing was limited to either
  • Women in labor before cesarean delivery (8.1% vs 13.8%; RR 0.52, 95% CI 0.28-0.97)
  • Women with ruptured membranes (4.3% vs 20.1%; RR 0.23, 95% CI 0.10-0.52)

CONCLUSION:

• Current study is aligned with previous Cochrane Review
• Authors recommend preoperative vaginal preparation before cesarean delivery for women in labor and/or with ruptured membranes
  • povidone-iodine 10% for at least 30 seconds using a sponge stick
• More research required to extend this intervention to women not laboring and who do not have ruptured membranes

Learn More – Primary Sources:

Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis

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Plastic-Sheath Wound Retractors Decrease C-Section Infection

What Risk Factors Increase Likelihood of C-Section Infection?

Which is the Better Suture to Prevent C-Section Wound Complications?