Vaginal cleansing with chlorhexidine gluconate or povidone-iodine prior to cesarean delivery: a randomized comparator-controlled trial

Lakhi, Nisha; Tricorico, Gabrielle; Osipova, Yevgeniya; Moretti, Michael

doi:10.1016/j.ajogmf.2019.03.004

Cited by 27 publications

(40 citation statements)

References 23 publications

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“…This fact was observed among the women in the control arm, where the incidence of endometritis (26.7%) and composite post‐CS infectious morbidities (36.8%) were very high as compared with the intervention arm. The benefit of antiseptic cleansing of the vagina in the reduction of post‐cesarean endometritis has been shown by various studies of Aref et al, 31 Starr et al, 32 Ahmed et al, 33 and Lakhi et al 29 Support for this beneficial role was seen in our study, as there was a markedly reduced risk of endometritis in women who received vaginal cleansing (RR = 0.29, 95% CI 0.16‐0.53; P < .05). This benefit is much more marked in women that are in labor before abdominal delivery.…”

Section: Discussionmentioning

confidence: 96%

“…This finding could be attributed to the antiseptic properties of chlorhexidine gluconate solution, 28 which was enhanced by the multiple numbers of times the vagina was cleaned with the solution in our study. Lakhi et al 29 reported the beneficial role of vaginal cleansing with chlorhexidine in reducing postpartum infection, in which the rate of wound infection was significantly lower in the chlorhexidine arm than povidone‐iodine (0.6% vs 2.0%; P = .039). However, our study was not supported by the findings of Rouse et al 18 in the USA, who reported a nonsignificant reduction in endocervical colonization and endometritis among their study population following labor.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative vaginal cleansing with chlorhexidine solution in preventing post‐cesarean section infections in a low resource setting: A randomized controlled trial

Ogah

Ajah

Ikeotuonye

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post‐cesarean section infectious morbidities. Material and methods This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE‐FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine‐alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine‐alcohol. All the women received pre‐ and postoperative antibiotics. The primary outcomes were endometritis and wound infections. Results Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16‐0.53; P < .05). Foul‐smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30‐64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species. Conclusions Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post‐cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Preoperative vaginal cleansing with chlorhexidine solution in preventing post‐cesarean section infections in a low resource setting: A randomized controlled trial

Ogah

Ajah

Ikeotuonye

et al. 2021

Acta Obstet Gynecol Scand

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show abstract

“…We would like to thank Drs Migliorelli and Martinez De Tejada for their thoughtful comments. 1 They raise an important issue regarding which patients could benefit most from vaginal cleansing before cesarean delivery (CD). The group of nonemergent CDs in our study included both scheduled CD (eg, breech/transverse presentation, repeat CD declining a trial of labor, multifetal delivery, macrosomia) and those that occurred after a trial of labor (arrest disorders, maternal request while laboring, category II fetal heart tracings, and failed inductions with trial of labor).…”

Section: Replymentioning

confidence: 99%

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Lakhi

2019

American Journal of Obstetrics & Gynecology MFM

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“…TO THE EDITORS: We read with great interest the recent article by Lakhi et al 1 Indeed, abdominal preparation protocols increasingly are using chlorhexidine as a disinfectant because it appears to have a better antibacterial profile, 2 without concerns related to interference on maternal or fetal thyroid affectation. 3 The fact that chlorhexidine decreases wound complications while being equivalent to povidone-iodine in terms of the incidence of other infections may help promote the implementation of vaginal cleansing as part of the presurgical routine.…”

mentioning

confidence: 99%

“…Most data regarding vaginal cleansing showed a benefit when the intervention was applied in emergent cesarean deliveries, although it remains uncertain if the same procedure will have an impact on scheduled interventions. 4 We carefully looked at the population in the study by Lakhi et al, 1 but we were unable to clearly define which types of surgery were included. For example, the abstract refers to "nonemergent cesarean deliveries," although the Editor's note mentions "non-scheduled (.)…”

mentioning

confidence: 99%