2020 Cochrane Review Update: Does Vaginal Cleansing Before Cesarean Reduce Postoperative Infection?
BACKGROUND AND PURPOSE:
Haas et al. (Cochrane Systematic Review – Intervention, 2020) sought to determine if vaginal cleansing with an antiseptic solution before cesarean delivery decreases the risk of maternal infectious morbidities
Systematic review and meta-analysis update
Data sources (through July 7, 2019)
Cochrane Pregnancy and Childbirth’s Trials Register | ClinicalTrials.gov | WHO International Clinical Trials Registry Platform (ICTRP)
Study inclusion criteria
RCTs and quasi-RCTs
Studies that assessed the impact of vaginal cleansing immediately before cesarean delivery on post-cesarean infectious morbidity with any type of antiseptic solution vs a placebo or standard of care
Study exclusion criteria
Vaginal prep used during labor | Antibiotic surgical prophylaxis was not administered | Cross-over design
At least three authors independently assessed eligibility of the studies
Two authors extracted study characteristics, quality assessments, and data from eligible studies
21 trials | 7038 women | 10 different countries
Povidone-iodine cleansing: 17 studies
Chlorhexidine cleansing: 3 studies
Benzalkonium chloride cleansing: 1 study
Studies used vaginal preparations administered by sponge sticks, douches, or soaked gauze wipes
No vaginal preparation: 17 studies
Saline vaginal preparation: 4 trials
Vaginal cleansing and Maternal morbidities
Vaginal preparation probably reduces the incidence of post-cesarean endometritis | Moderate-certainty evidence
Control groups: 7.1%
Cleansing groups: 3.1%
Average risk ratio (aRR) 0.41 (95% CI, 0.29 to 0.58; 20 trials, 6918 women)
The reduction in endometritis was seen for both iodine-based solutions and chlorhexidine-based solutions
Vaginal prep probably reduces the risks of postoperative fever and postoperative wound infection | Both moderate-certainty evidence
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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