The effect of vaginal cleansing performed with normal saline solution or povidone-iodine before elective caesarean section on postoperative maternal morbidity and infection; A prospective randomized controlled study

Objective: The present study was designed to determine the effect of vaginal cleansing performed with saline solution or povidoneiodine before elective cesarean section on postpartum maternal morbidity and postoperative infection. Patients and Methods: One hundred and eighty primiparae, awaiting elective caesarean section, were assigned into the following three groups, Group1 (saline solution vaginal cleansing for 30s, n:60); Group2 (povidone-iodine vaginal cleansing for 30s, n:60); Group3 (control group, n:60). Results: There were statistically significant differences between the 3 groups in terms of the median values for the postoperative C-reactive protein (CRP) and fever, and visual analogue scale (VAS) score (p<0.001). The median value for the postoperative CRP level was 26.5 mg/dl, 59.5mg/dl and 62.3mg/dl in the saline solution, povidone-iodine and control groups respectively. The median value for the VAS score was 3,4 and 4; the incidence of the patients with fever >38°C was 1.7%, 3.4% and 10% in the saline solution, povidone-iodine and control groups, respectively. Conclusion: Vaginal cleansing with normal saline solution or povidone-iodine before caesarean section significantly reduced postoperative pain, fever, and CRP levels. Cleansing of the vagina before cesarean section clinically reduced the number of postcaesarean wound site infections, and endometritis; however, the reduction was not statistically significant.

Keywords:

Caesarean section, Maternal morbidity, Postoperative infection, Vaginal cleansing, Saline solution Povidone-iodine,

PDF

___

Yildirim G, Güngördük K, Asicioglu O, et al. Does vaginal preparation with povidoneiodine prior to caesarean delivery reduce the risk of endometritis? A randomized controlled trial. J Matern Fetal Neonatal Med 2012;25: 2316-21. doi: 10.3109/14767.058.2012.693994.
Haas DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev 2014; 12: CD007892. doi: 10.1002/14651858.CD007892.
Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014;10:CD007482. doi: 10.1002/14651858.CD007482.
Haas DM, Pazouki F, Smith RR, et al. Vaginal cleansing before cesarean delivery to reduce postoperative infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol 2010; 202: 311-16. doi: 10.1016/j.ajog.2010.01.005.
Abdallah AA. Evaluation of the risk of postcesarean endometritis with preoperative vaginal preparation with povidone–iodine: a randomized controlled study. Middle East Fertil Soc J 2015;20:246-50. https://doi.org/10.1016/j. mefs.2015.03.002
Hadiati DR, Hakimi M, Nurdiati DS, et al. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Rev 2014;9:CD007462. doi: 10.1002/14651858. CD007462.
Berrıos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017; 152: 78491. doi: 10.1001/jamasurg.2017.0904.
Amstey MS, Jones AP. Preparation of the vagina for surgery. A comparison of povidone-iodine and saline solution. JAMA 1981;245: 839-41.
Asghania M, Mirblouk F, Shakiba M, Faraji M. Preoperative vaginal preparation with povidone-ıodine on post-caesarean ınfectious morbidity. J Obstet Gynaecol 2011;3:400-3.doi: 10.3109/01443.615.2011.568644.
Haas DM, Morgan S, Contreras K, Enders S, et al. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev 2018; 7: CD007892. doi: 10.1002/14651858.CD007892.
Aref NK. Vaginal cleansing prior to caesarian section: To do or not to do? A randomized trial. J Gynecol Obstet Hun Reprod 2019;48: 65-8. doi: 10.1016/j.jogoh.2018.11.002.
Caissutti C, Saccone G, Zullo F, et al. Vaginal cleansing before cesarean delivery: A systematic review andmetaanalysis. Obstet Gynecol 2017;130:527-38.doi: 10.1097/ AOG.000.000.0000002167.
Reid VC, Hartmann KE, McMahon M, Fry EP. Vaginal preparation with povidone iodine and postcesarean infectious morbidity: a randomized controlled trial. J Obstet Gynecol 2001;97: 147-52. doi: 10.1016/s0029-7844(00)01087-5.
Starr RV, Zurawski J, Ismail M. Preoperative vaginal preparation with povidone-iodine and the risk of post cesarean endometritis. J Obstet Gynecol 2005;105:1024-9. doi: 10.1097/01.AOG.000.016.4032.16599.7e.
La Rosa M, Jauk V, Saade G, et al. Institutional protocols for vaginal preparation with antiseptic solution and surgical site infection rate in women undergoing cesarean delivery during labor. Obstet Gynecol 2018;2:371-6. doi: 10.1097/ AOG.000.000.0000002745.
Felder L, Paternostro A, Quist-Nelson J, Baxter J and Berghella V. Implementation of vaginal cleansing prior to cesarean delivery to decrease endometritis rates. J Matern-Fetal Neonatal Med 2018;32:1997-2002. doi: 10.1080/14767.058.2017.1422717.
Güngördük K, Asicioglu O, Celikkol O, Ark C, Tekırdağ AI. Does saline irrigation reduce the wound infection in caesarean delivery? J Obstet Gynecol 2010; 30: 662-6. doi: 10.3109/01443.615.2010.494206.
Jafarzadeh L, Hojjati H. Effect of normal saline on cleaning uterine cavity during cesarean delivery. J Clin Diagn Res 2016;7: QC11-QC13. doi: 10.7860/JCDR/2016/17663.8151.
Göymen A, Şimşek Y, Özdurak Hİ, et al. Effect of vaginal cleansing on postoperative factors in elective caesarean sections: a prospective, randomised controlled trial. J Matern-Fetal Neonatal Med 2017;30:442-5.doi: 10.1080/14767.058.2016.1174995.
Bond M R, Pilowsky I. Subjective assessment of pain and its relationship to the administration of analgesics in patients with advanced cancer. J Psychosom Res 1966;10:203-8. doi: 10.1016/0022-3999(66)90064-X
Rouse DJ, Hauth JC, Andrews WW, Mills BB, Maher JE. Chlorhexidine vaginal irrigation for the prevention of peripartal infection: a placebo-controlled randomized clinical trial. Am J Obstet Gynecol 1997;176: 617-22. doi: 10.1016/ s0002-9378(97)70557-x.
Sweeten KM, Eriksen NL, Blanco JD. Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection. Am J Obstet Gynecol 1997;176:426-30. doi: 10.1016/ s0002-9378(97)70510-6.
Guzman MA, Prien SD, Blann DW. Postcesarean related infection and vaginal preparation with povidone-iodine revisited. Primary Care Update for OB/GYNS 2002;9:206-9.