Preoperative Vaginal Cleansing As Strategy To Decrease Infection Risk In Unscheduled Caesarean Delivery

A new study published in the American Journal Of Obstetrics And Gynaecology has revealed that preoperative vaginal cleansing with povidone-iodine before an unscheduled caesarean delivery following labour does not significantly decrease postoperative infectious morbidity. Caesarean deliveries are the most common major surgeries performed on women, and surgical-site infections are a significant source of postoperative complications. However, the effectiveness of vaginal cleansing in reducing infection rates has remained uncertain.

The objective of the study was to evaluate whether preoperative vaginal cleansing with povidone-iodine among women undergoing a caesarean delivery after labour would result in a decrease in postoperative infectious morbidity. The randomised clinical trial conducted by Lorene A. Temming and colleagues involved a total of 608 participants who met the inclusion criteria and were randomly assigned to receive either abdominal cleansing plus vaginal cleansing with 1% povidone-iodine or abdominal cleansing alone.

The primary outcome measured was the composite infectious morbidity, which included surgical-site infection, fever, endometritis, and wound complications within 30 days after the caesarean delivery. Secondary outcomes included individual components of the composite, length of hospital stay, postoperative hospitalization or outpatient treatment related to infectious morbidity, and empirical treatment for neonatal sepsis.

The findings of the study were:

● In the study, a total of 608 participants, with 304 in the vaginal cleansing group and 304 in the control group, were included in the intention-to-treat analysis.

● The patient characteristics were comparable between the two groups.

● The primary composite outcome, which included surgical-site infection, fever, endometritis, and wound complications within 30 days after the caesarean delivery, did not show a significant difference between the two groups (11.8% vs. 11.5%; P=.90; relative risk, 1.0; 95% confidence interval, 0.7–1.6).

● The individual components of the composite outcome and secondary outcomes did not exhibit any significant differences between the groups.

● Similar results were obtained in the as-treated analysis (11.3% vs. 11.8%; P=.9; relative risk, 1.0; 95% confidence interval, 0.7–1.6).

Based on these results, the study does not support the routine use of vaginal cleansing with povidone-iodine for women undergoing a caesarean delivery after labour. It highlights the need for further research to identify other strategies or interventions that may effectively reduce postoperative infectious morbidity in this population.

Clinicians and healthcare providers should consider these findings when making decisions regarding preoperative vaginal cleansing for unscheduled cesarean deliveries. Individualized treatment plans and adherence to existing infection prevention protocols remain crucial in reducing the risk of postoperative complications. Further studies are warranted to explore alternative strategies that may improve outcomes and minimize infectious morbidity in women undergoing cesarean deliveries.

Reference:

Temming, L. A., Frolova, A. I., Raghuraman, N., Tuuli, M. G., & Cahill, A. G. (2023). Vaginal cleansing before unscheduled cesarean delivery to reduce infection: a randomized clinical trial. American Journal of Obstetrics and Gynecology, 228(6), 739.e1-739.e14. https://doi.org/10.1016/j.ajog.2022.11.1300.