Efficacy of betadine vaginal toileting before caesarean section in postoperative infections

Tarang Preet Kaur; Asmita M. Rathore; Latika Sahu

doi:10.18203/2320-1770.ijrcog20202329

Authors

Tarang Preet Kaur Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
Asmita M. Rathore Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
Latika Sahu Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20202329

Keywords:

Betadine vaginal toileting, Infections, Post caesarean section

Abstract

Background: The objective of the current study was to evaluate the efficacy of preoperative betadine vaginal toileting in reducing post caesarean infections (endometritis, febrile illness, wound sepsis).

Methods: This prospective longitudinal study was conducted at Maulana Azad Medical College, New Delhi over 3 months among 200 women who underwent caesarean delivery. Inclusion criteria were defined as women undergoing caesarean section. Exclusion criteria included placenta previa, active genital herpes, cord prolapse, chorioamnionitis, allergy to iodine. After taking informed consent, subjects were divided into two groups by simple randomization method using computer generated random numbers- Group 1 (case) - subjects who underwent 5% povidone iodine sponge stick cleansing in all the fornices and walls of vagina for 30 seconds after foley’s catheter insertion and before abdominal scrubbing. Group 2 (control) - subjects who didn't receive betadine vaginal toileting before caesarean section Subjects were followed for 10 days postpartum (or till suture removal/ discharge from hospital, whichever was late). Demographic data, operative details and postoperative parameters were compared between the two groups.

Results: Both groups were matched for baseline patients’ characteristics (age, BMI, gestational age, operative time). Women who received preoperative betadine vaginal toileting had markedly less incidence of endometritis (case-3%, control-10%, p<0.05), overall postoperative morbidity (case-13%, control-33%, p<0.001). Incidence of postoperative febrile illness (case-6%, control-12%, p>0.05) and wound sepsis (case-5%, control-12%, p>0.05) were found to be less but not significant between both groups.

Conclusions: Preoperative vaginal cleansing helps in reducing postoperative morbidity by decreasing incidence of postoperative infection.

Metrics

Metrics Loading ...

References

Declercq E, Barger M, Cabral HJ, Evans SR, Kotelchuck M, Simon C, et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol. 2007;109:669-77.

Caissutti C, Saccone G, Zullo F, Quist-Nelson J, Felder L, Ciardulli A, et al. Vaginal cleansing before cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol. 2017;130(3):527-38.

Nandi JK, Saha DP, Pal S, Barman S, Mitra A. Antiseptic vaginal preparation before cesarean delivery to reduce post-operative infection: a randomized controlled trial. JMSCR. 2015;3:4310-5.

French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. The Cochrane Database Syst Rev. 2004;2:Art. No.: CD001067.

Smaill FM, Grivell RM. Antibiotic prophylaxis versus no pro- phylaxis for preventing infection after cesarean section. The Cochrane Database Syst Rev. 2014:Art. No.:CD007482.

Asghania M, Mirblouk F, Shakiba M, Faraji R. Preoperative vaginal preparation with povidone-iodine on post-caesarean infectious morbidity. J Obstet Gynaecol. 2011;31:400-3.

Starr RV, Zurawski J, Ismail M. Preoperative vaginal preparation with povidone-iodine and the risk of post-cesarean endometritis. Obstet Gynecol. 2005;105:1024-9.

Guzman MA, Prien SD, Blann DW. Post-cesarean related infection and vaginal preparation with povidone-iodine revisited. Prim Care Update Obstet Gynecol. 2002;9:206-9.

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;61:1179-83.

Amstey MS, Jones AP. Preparation of the vagina for surgery. A comparison of povidone-iodine and saline solution. JAMA. 1981;245:839-41.

Haas DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2014;12:CD007892.