Abstract:Use of 1% CHX is safe for neonates, well tolerated by laboring mothers, and effective in treating vaginal infections during labor. A randomized controlled trial using 1% CHX and powered for a reduction in neonatal septic mortality is justified based on these data.
“…Characteristics of included studies are detailed in Table 1 , including potential confounding factors. Only two of the studies [ 27 , 40 ] were undertaken in low resource settings (Table 1 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…2 ). Two studies [ 21 , 27 ] investigated the effect of chlorhexidine on maternal colonization, including 53 participants in the intervention group and 51 in the control group, which also showed no significant difference on colonization (Relative risk (RR) 0.61, 95% confidence intervals (CI) 0.05-8.08) Heterogeneity – I 2 = 93%, P < 0.001. Fig.…”
BackgroundInfection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity.The objective of this systematic review is to review the effectiveness of intrapartum vaginal chlorhexidine in the reduction of maternal and neonatal colonisation and infectious morbidity.MethodsSearch strategy – Eight databases were searched for articles published in any language from inception to October 2016.Selection criteria – Randomised controlled trials were included.Data Collection and analysis - Publications were assessed for inclusion. Data were extracted and assessed for risk of bias.Relative risks from individual studies were pooled using a random effects model and the heterogeneity of treatment was evaluated using Chi2 and I2 tests.ResultsEleven randomised controlled trials (n = 20,101) evaluated intrapartum vaginal chlorhexidine interventions. Meta-analysis found no significant differences between the intervention and control groups for any of the four outcomes: maternal or neonatal colonization or infection. The preferred method for chlorhexidine administration was vaginal irrigation.ConclusionsMeta-analysis did not demonstrate improved maternal or neonatal outcomes with intrapartum vaginal chlorhexidine cleansing, however this may be due to the limitations of the available studies. A larger, multicentre randomised controlled trial, powered to accurately evaluate the effect of intrapartum vaginal chlorhexidine cleansing on neonatal outcomes may still be informative; the technique of douching may be the most promising.
“…Characteristics of included studies are detailed in Table 1 , including potential confounding factors. Only two of the studies [ 27 , 40 ] were undertaken in low resource settings (Table 1 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…2 ). Two studies [ 21 , 27 ] investigated the effect of chlorhexidine on maternal colonization, including 53 participants in the intervention group and 51 in the control group, which also showed no significant difference on colonization (Relative risk (RR) 0.61, 95% confidence intervals (CI) 0.05-8.08) Heterogeneity – I 2 = 93%, P < 0.001. Fig.…”
BackgroundInfection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity.The objective of this systematic review is to review the effectiveness of intrapartum vaginal chlorhexidine in the reduction of maternal and neonatal colonisation and infectious morbidity.MethodsSearch strategy – Eight databases were searched for articles published in any language from inception to October 2016.Selection criteria – Randomised controlled trials were included.Data Collection and analysis - Publications were assessed for inclusion. Data were extracted and assessed for risk of bias.Relative risks from individual studies were pooled using a random effects model and the heterogeneity of treatment was evaluated using Chi2 and I2 tests.ResultsEleven randomised controlled trials (n = 20,101) evaluated intrapartum vaginal chlorhexidine interventions. Meta-analysis found no significant differences between the intervention and control groups for any of the four outcomes: maternal or neonatal colonization or infection. The preferred method for chlorhexidine administration was vaginal irrigation.ConclusionsMeta-analysis did not demonstrate improved maternal or neonatal outcomes with intrapartum vaginal chlorhexidine cleansing, however this may be due to the limitations of the available studies. A larger, multicentre randomised controlled trial, powered to accurately evaluate the effect of intrapartum vaginal chlorhexidine cleansing on neonatal outcomes may still be informative; the technique of douching may be the most promising.
“…However, safety and feasibility of home-based parenteral antibiotic therapy must be carefully assessed before it can be recommended as an alternative to facility-based care. The systematic review also concluded that in situations without available hospitalbased care, the combination of clean birth practices [25] and prompt initiation of oral antibiotic therapy for potentially serious neonatal infections were likely to be of substantial benefit. The most effective and safe enteral antibiotics identified included co-trimoxazole, secondgeneration cephalosporins, ciprofloxacin, amoxicillin, and combined amoxicillin-clavulanic acid.…”
Management tools for community-based care of mothers with puerperal sepsis-including early detection, initiation of broad-spectrum antibiotic treatment, and timely referral-should be added to those currently in use for neonatal sepsis. Further research is required to address acceptability, feasibility, and impact of community-based presumptive treatment.
“…For patients who are allergic, diluted 4% chlorhexidine gluconate is used. 9 The staff member performing the prep uses cotton tip applicators with iodine paint to clean the umbilicus of detritus (ie, debris). Next, each foam sponge is dipped in the scrub solution to vigorously scrub, in sequence, the abdomen, top third of the thighs, perineum, and vulva, and then the vaginal interior up to and around the cervix; the sponge is discarded after the anus is swabbed (Figure 1).…”
Section: Methodsmentioning
confidence: 99%
“…First, it is confirmed that the patient is not allergic to external iodine preparations. For patients who are allergic, diluted 4% chlorhexidine gluconate is used 9 . The staff member performing the prep uses cotton tip applicators with iodine paint to clean the umbilicus of detritus (ie, debris).…”
The vulva and vaginal interior are considered a contaminated surgical area, and current OR guidelines require surgeons who are gloved and gowned at the abdominal field to avoid contact with the urethral catheter, the uterine manipulator, and the introitus or to change their gloves and even regown if contact occurs. It is our belief that the perception of the vaginal field as contaminated reflects a lack of specific standards for the preoperative cleansing of the deeper vagina and a lack of preoperative prep instructions for the combined fields. We developed a comprehensive single-field prep technique designed to improve surgical efficiency and prevent contamination of the sterile field. Combining a methodical scrub, prep, and dwell, this technique allows the entire abdomino-perineovaginal field to be treated as a single sterile field for laparoscopic procedures. Our surgical site infection rate of 1.8% when using this single-field prep technique and the subsequent surgical treatment of the abdominal, vaginal, and perineal fields as a single sterile field is well within reported norms.
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