Vaginal preparation with povidone iodine solution before caesarean section and its impact on the post-operative infectious morbidity
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20212667Keywords:
Post caesarean infectious morbidity, Pre-operative vaginal wash, Povidone iodineAbstract
Background: A prospective randomized control trial (RCT) was conducted in the department of obstetrics and gynecology. The aim of the study was to evaluate the effect of pre-operative vaginal preparation with 1% povidone iodine solution on the post-operative caesarean infectious morbidity.
Methods: 72 women were enrolled in the experimental group who received 1% povidone iodine vaginal wash and 72 in the control group who did not receive any vaginal wash. The investigators were blinded to the computer-generated random number table and to the allocation group. The clinical data was recorded and after its completion, the allocation group was revealed to the investigator. The data was tabulated and statistically analyzed using SPSS 21.
Results: Age, parity, BMI, gestational age, blood loss, and operative time between the two groups was comparable. Pre-operative povidone iodine vaginal wash was more effective when membranes were intact versus ruptured. With intact membranes, statistical significance was reached for postoperative fever, seroma, endometritis, gaped incisional site, and foul discharge with p value 0.012, 0.012, 0.013, 0.027 and 0.012 respectively, between group A and B. The overall infectious morbidity in the 144 subjects showed statistical significance for endometritis, and foul-smelling lochia with p value 0.049 and 0.024 respectively; urinary tract infection, hospital stay duration, and incisional wound dehiscence were higher in group B versus group A, the difference in these parameters did not reach statistical significance.
Conclusions: Pre-operative vaginal cleansing with 1% povidone iodine reduced post-operative infectious morbidity more effectively in those with intact membranes than ruptured membranes.
References
Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84.
Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet. 2005;90(1):10-5.
Opoien HK, Valbo A, Grinde AA, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097-102.
Haas DM, Morgan S, Contreras K, Enders S. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2018;7(7):7892.
Lumbiganon P, Laopaiboon M, Gulmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet. 2010;375(9713):490-9.
Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-91.
WHO. WHO recommendations for prevention and treatment of maternal peripartum infections, 2015. Available at: https://www.who.int/reproductivehealth/publicationmaternalperhealth/peripartum-infectionguidelines/en. Accessed on 9 May 2021.
Memon S, Qazi RA, Bibi S, Parveen N. Effect of preoperative vaginal cleansing with an antiseptic solution to reduce post caesarean infectious morbidity. J Pak Med Assoc. 2011;61(12):1179-83.
Asghania M, Mirblouk F, Shakiba M, Faraji R. Preoperative vaginal preparation with povidone-iodine on post-caesarean infectious morbidity. J Obstet Gynaecol. 2011;31(5):400-3.
Aref NK. Vaginal cleansing prior to caesarian section: To do or not to do?: A randomized trial. J Gynecol Obstet Human Reprod. 2019;48(1):6568.
Kaur TP, Rathore AM, Sahu L. Efficacy of betadine vaginal toileting before caesarean section in postoperative infections. Int J Reprod Contracept Obstet Gynecol. 2020;9(6):2457-62.
Yildirim G, Gungorduk K, Asicioglu O, Basaran T, Temizkan O, Davas I, et al. Does vaginal preparation with povidone-iodine prior to caesarean delivery reduce the risk of endometritis? A randomized controlled trial. J Matern Fetal Neonatal Med. 2012;25(11):2316-21.