Reduce Post-Cesarean Infections With Vaginal Antiseptic Solution

The risk of postoperative endometritis is reduced when a vaginal preparation of povidone-iodine is administered immediately before cesarean delivery, according to the conclusions of an intervention review by the Cochrane Pregnancy and Childbirth Group.¹
   
Cesarean delivery is the most common obstetrical surgery performed today. Although relatively safe, cesarean delivery is not without risk. Endometritis, an infection of the uterus, is a common risk factor associated with cesarean delivery. The reported incidence of pregnancy-related endometritis has ranged from 13% to 90%, depending on patient risk factors and whether prophylactic antibiotics were administered prior to cesarean delivery.² In the United States, prophylactic antibiotics are typically administered before cesarean delivery to help reduce the risk of postoperative infectious morbidities. Despite this precaution, endometritis complicates approximately 25% of cases of cesarean delivery, and 10% of cases are complicated by problems related to the surgical incision. In new mothers, these postoperative complications can hinder their return to normal function, significantly affecting their ability to care for their newborns.
   
To determine whether cleansing the vagina with an antiseptic solution before a cesarean delivery can decrease the risk of maternal infectious morbidities, such as endometritis and wound complications, researchers analyzed the results of 5 relevant trials that involved 1946 women. All analyses, however, were based on data from 1766 women. In the included trials, vaginal preparation with povidone-iodine occurred immediately before cesarean delivery.
   
Compared with women in the control groups, women in the vaginal cleansing groups had significantly lower rates of post-cesarean endometritis (3.6% vs 7.2%; P = 0.05; based on 5 trials, 1766 women). This risk reduction was especially notable among women with ruptured membranes; the rate of endometritis was 1.4% in the treatment group, compared with 15.4% in the control group (P = 0.05; based on 2 trials, 148 women). Vaginal cleansing was not associated with a reduction in any other adverse outcomes, such as fever or wound complications. None of the studies noted any adverse events, such as allergy or irritation, related to antiseptic use.
   
Based on these findings, the researchers recommended that obstetricians should consider preoperative vaginal cleansing with povidone-iodine before performing cesarean deliveries, especially in women whose membranes have ruptured.

Pertinent Points:
- Vaginal preparation with the antiseptic solution povidone-iodine immediately before cesarean section significantly reduces the rate of endometritis.
- This simple, low-cost intervention should be included among the precautions surgeons use to reduce the incidence of postoperative infectious morbidities, especially in women with ruptured membranes.
 

References:

1. Haas DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2013;1:CD007892.
2. Rivlin ME, Alderman E, Chandran L, et al. Endometritis. Available at: http://emedicine.medscape.com/article/254169-overview#showall. Accessed March 29, 2013.