Vaginal cleansing useful in preventing endometritis following caesarean delivery
Vaginal cleansing immediately prior to caesarean delivery in women who are in labour and have ruptured membranes may lower the risk of developing postoperative endometritis, according to a meta-analysis.
Researchers accessed several electronic databases for randomized controlled trials comparing the efficacy of vaginal cleansing (any method with any type of antiseptic solution; intervention group) with either placebo or no intervention (control group) in preventing endometritis in women undergoing a caesarean procedure.
A total of 16 trials involving 4,837 women were included in the analysis. Most of the studies performed cleansing with 10% povidone-iodine and using a sponge stick for approximately 30 seconds.
Pooled data showed that compared with the control group, the intervention group had a significantly lower incidence of postcaesarean delivery endometritis (4.5 vs 8.8 percent; relative risk [RR], 0.52; 95 percent CI, 0.37 to 0.72; 15 studies; n=4,726) and of postoperative fever (9.4 vs 14.9 percent; RR, 0.65; 0.50 to 0.86; 11 studies; n=4,098).
In the planned subgroup analyses, the protective effect of vaginal cleansing against the incidence of endometritis was limited to women in labour before caesarean delivery (8.1 vs 13.8 percent; RR, 0.52; 0.28 to 0.97; four studies; n=440) and in those with ruptured membranes (4.3 vs 20.1 percent; RR, 0.23; 0.10 to 0.52; three studies; n=272).
In light of the present data and the fact that vaginal cleansing is a generally inexpensive and simple intervention, researchers recommended performance of vaginal cleansing prior to caesarean delivery in women who are either in labour or with ruptured membranes using a sponge stick preparation of povidone-iodine 10 percent for at least 30 seconds.
Additional studies are warranted to evaluate whether vaginal cleansing may be also useful for caesarean deliveries performed in women not in labour and those without ruptured membranes, researchers said.
Caesarean delivery is the most important risk factor for postpartum maternal infection, with women undergoing such procedure having a five to 20 times greater risk of infection and infectious morbidity compared with those undergoing a vaginal birth. The most common postcaesarean infective complications include endometritis (6 to 27 percent), clinically significant fever (5 to 24 percent) and wound infection (2 to 9 percent). [Obstet Gynecol 2007;109:669–77]