A Cochrane review [Abstract] 1 included three studies on chlorhexidine vaginal douching during labour for reducing infections (excluding group B streptococcal and HIV), with a total of 3012 subjects. There was no evidence of an effect of vaginal chlorhexidine during labour in preventing maternal and neonatal infections. Although the data suggest a trend in reducing postpartum endometritis, the difference was not statistically significant (relative risk 0.83; 95% confidence interval 0.61 to 1.13).
Another Cochrane review 2 (abstract , review [Abstract]) included 5 studies on the effectiveness of vaginal disinfection with chlorhexidine during labour for preventing early-onset group B streptococcal infections, involving approximately 2190 infants. When all studies were combined there was a reduction in colonisation of group B streptococcus (RR 0.72, 95% CI 0.56-0.91); NNT 6 (95% CI 4-20). There was no statistically significant reduction in early-onset disease including GBS infection, GBS pneumonia, GBS meningitis or mortality.
A meta-analysis 3 included 11 trials involving a total of 20 101 women. There was no significant differences between the intervention (mostly vaginal chlorhexidine irrigation) and control groups for any of the four outcomes: maternal or neonatal colonization or infection.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
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