Effect of vaginal cleansing with povidone iodine prior to emergency caesarean section on post-operative infectious morbidity in a Nigerian tertiary hospital

Nathaniel Ketare; Habiba I. Abdullahi; Malachy E. Ayogu; Rabiat M.  Ahmed; Ishak K. Lawal; Dennis A. Isah; Nathaniel D. Adewole; Aliyu Y. Isah; Bissallah A. Ekele

doi:10.18203/2320-1770.ijrcog20260156

Authors

Nathaniel Ketare Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin-Kebbi, Nigeria
Habiba I. Abdullahi Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria
Malachy E. Ayogu Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria
Rabiat M. Ahmed Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria
Ishak K. Lawal Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin-Kebbi, Nigeria
Dennis A. Isah Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria
Nathaniel D. Adewole Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria
Aliyu Y. Isah Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria
Bissallah A. Ekele Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260156

Keywords:

Endometritis, Povidone iodine, Surgical-site infection, Vaginal-cleansing, Caesarean section, Infectious morbidity

Abstract

Background: Post-caesarean infectious morbidities, including endometritis and wound infections, remain significant contributors to maternal morbidity, particularly in low-resource settings. This study evaluated the effectiveness of preoperative vaginal cleansing with 10% povidone iodine in reducing post-operative infections following emergency caesarean section.

Methods: We conducted a randomized controlled trial involving 266 pregnant women booked for emergency caesarean section randomly assigned to either intervention group with povidone iodine vaginal cleansing (n=133) or control group with no vaginal preparation (n=133). Routine prophylactic antibiotics were administered to all participants. The primary outcome was the incidence of post-caesarean endometritis and the secondary outcome was surgical site infection.

Results: Of the 266 participants enrolled, only 260 were analysed, 37 (14.2%) of whom developed infectious morbidity. Twenty-nine (22.1%) had infectious morbidity in the control group and 8 (6.2%) in the intervention group. Endometritis occurred in 18 (13.7%) of the control and 4 (3.1%) in the intervention group (p=0.01). Wound infection occurred in 11 (8.4%) of the control and 4 (3.1%) in the intervention group (p=0.07). Vaginal cleansing significantly reduced the risk of endometritis [Risk ratios (RR)=0.21, absolute risk reduction (ARR)=0.11; number needed to treat (NNT=9)] and wound infection (RR=0.38, ARR=0.05; NNT=20), with no reported adverse effects.

Conclusions: Preoperative vaginal cleansing with 10% povidone iodine significantly reduced the incidence of post-caesarean endometritis and wound infection. It is a simple, safe, and cost-effective intervention that can improve maternal outcomes, especially in women with prolonged labour or ruptured membranes.

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