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Evidence summaries

Vaginal Preparation with Antiseptic Solution Before Caesarean Section for Preventing Postoperative Infections

Vaginal preparation with povidone-iodine or chlorhexidine solution immediately before caesarean delivery appears to reduce the risk of postoperative endometritis compared with saline or no preparation. Level of evidence: "B"

The quality ov evidence is downgraded by study limitations (unclear allocation concealment or blinding in half of the studies).

A Cochrane review [Abstract] cd007892 included 21 studies with a total of 7038 subjects. Vaginal preparation (povidone-iodine- and chlorhexidine-based solutions) immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 7.1% in control groups to 3.1% in vaginal cleansing groups (average risk ratio (aRR) 0.41, 95% CI 0.29 to 0.58; 20 trials, n=6918). Risks of postoperative fever and postoperative wound infection were reduced (fever: aRR 0.64, 0.50 to 0.82; 16 trials, n=6163; and wound infection: RR 0.62, 95% CI 0.50 to 0.77; 18 trials, n=6385).

    References

    • Haas DM, Morgan S, Contreras K et al. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev 2020;(4):CD007892. [PubMed]

Primary/Secondary Keywords