Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections

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#administration-intravaginal #anti-infective-agents-local #cesarean-section #disinfection #endometritis

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections

Haas et al., 2010 | Cochrane Database Syst Rev | Meta Analysis

Citation

Haas David M, Morgan Al Darei Sarah, Contreras Karenrose. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2010-Mar-17(3):CD007892. doi:10.1002/14651858.CD007892.pub2

Abstract

BACKGROUND: Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. OBJECTIVES: To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2009). SELECTION CRITERIA: We included randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. DATA COLLECTION AND ANALYSIS: We independently assessed eligibility and quality of the studies. MAIN RESULTS: Four trials (involving 1361 randomized and 1198 analyzed women) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 9.4% in control groups to 5.2% in vaginal cleansing groups (risk ratio (RR) 0.57, 95% confidence interval (CI) 0.38 to 0.87, four trials, 1198 women). The risk reduction was particularly strong for women with ruptured membranes (1.4% in the vaginal cleansing group versus 15.4% in the control group; RR 0.13, 95% CI 0.02 to 0.66, two trials, 148 women). No other outcomes realized statistically significant differences between the vaginal cleansing and control groups. No adverse effects were reported with the povidone-iodine vaginal cleansing. AUTHORS' CONCLUSIONS: Vaginal preparation with povidone-iodine solution immediately before cesarean delivery reduces the risk of postoperative endometritis. This benefit is particularly realized for women undergoing cesarean delivery with ruptured membranes. As a simple, generally inexpensive intervention, providers should consider implementing preoperative vaginal cleansing with povidone-iodine before performing cesarean deliveries.

Key Findings

Four trials (involving 1361 randomized and 1198 analyzed women) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 9.4% in control groups to 5.2% in vaginal cleansing groups (risk ratio (RR) 0.57, 95% confidence interval (CI)

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Administration, Intravaginal
  • Anti-Infective Agents, Local
  • Cesarean Section
  • Disinfection
  • Endometritis
  • Female
  • Humans
  • Povidone-Iodine
  • Pregnancy
  • Surgical Wound Infection
  • Vagina

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: iodine

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09