Chlorhexidine vs. sterile vaginal wash during labor to prevent neonatal infection

Abstract

Objective The purpose of this study was to determine if a dilute solution of chlorhexidine used as a one‐time vaginal wash intrapartum can reduce the use of postnatal antibiotics and neonatal infection. Methods Term pregnant women in labor were prospectively randomized to receive either 20 cc of 0.4% chlorhexidine (n = 481) or 20 cc of sterile water (n = 466) placebo. Exclusion criteria included fetal distress, clinical infection, cervical dilatation >6 cm, and known allergy to chlorhexidine. Outcome variables included the incidence of neonatal pneumonia, culture proven neonatal sepsis, and use of the antibiotics in the neonate. Continuous variables were compared using the Mann‐Whitney U‐test and discrete variables were compared with the chi‐square test. Results The length of ruptured membranes (mean ± S.D.) between the chlorhexidine group (408 ± 589 min) and control group (352 ± 318 min) was not significantly different (P = 0.85, 95% confidence interval 354–462). Fifteen neonates (3.2%) in the chlorhexidine group and 9 (1.9%) in the control group received antibiotics in the postnatal period (P = 0.32, 95% confidence interval 0.72–3.72). There was one case of pneumonia in the control group and no cases of sepsis in either group. Conclusions A one‐time chlorhexidine vaginal wash does not decrease the use of antibiotics or incidence of neonatal infection in our population. Infect. Dis. Obstet. Gynecol. 5:286–290, 1997. © 1998 Wiley‐Liss, Inc.

What is the result of vaginal cleansing with chlorhexidine during labour on maternal and neonatal infections? A systematic review of randomised trials with meta-analysis

“…In particular, different methods of vaginal cleansing with chlorhexidine were used. In eight studies [ 20 , 21 , 27 , 30 , 41 , 42 , 44 ] an irrigation or ‘douching’ method was used, whilst others used gel [ 23 ], wipes [ 40 ] or cream [ 22 ] . In the analysis of these treatment differences, douching was suggested to be more effective, but this may not be a reliable conclusion as only one study [ 42 ] with neonatal colonization as an outcome employed irrigation and only one study with maternal sepsis/infection as an outcome [ 40 ] used wipes.…”

“…The use of a control also varied between studies, with three [ 20 , 41 , 42 ] using sterile saline, three [ 28 , 30 , 44 ] using sterile water, one [ 23 ] using another placebo and four [ 21 , 22 , 27 , 40 ] using no intervention as controls. Aside from the lack of blinding in the non-treatment controls, confounding may have occurred in the use of saline or water.…”

“…The studies reviewed also differ in terms of the level of care provider carrying out the intervention, with four [ 20 , 21 , 40 , 42 ] using midwives and five [ 23 , 28 , 30 , 41 , 44 ] using doctors and/or medical students, two unknown [ 22 , 27 ]. However, the person(s) within each study responsible for performing the intervention (or control, where applicable) varied within the study itself, which may also have influenced outcomes.…”