Preoperative Vaginal Painting with Chlorhexidine Before Cesarean Deliveries to Reduce Postoperative Febrile Morbidity : a Randomized Controlled Trial

Authors

  • Chayada Worasatit M.D., Nakhonpathom Hospital

Keywords:

vaginal preparation, cesarean section, chlorhexidine, febrile morbidity

Abstract

          Objective: The aim was to study the effect of chlorhexidine preoperative vaginal preparation on the reduction of febrile morbidity after cesarean sections.

          Methods: This simple parallel two-group randomized controlled study was conducted at Nakhonpathom Hospital from January to June 2021. Two hundred women undergoing cesarean sections were included, then randomly divided into two groups. The study group, consisting of 100 women undergoing cesarean sections, received conventional preoperative cesarean preparations in combination with chlorhexidine vaginal painting before cesarean sections. The control group, consisting of 100 women who had cesarean sections received standard preoperative cesarean sections preparation, without vaginal preparation. Postoperative fever was recorded and analyzed.

          Results: The overall rate of febrile morbidity was 16 percent. The incidence of febrile morbidity was 13 and 19 percent in the study group and control group respectively. There was no statistically significant difference (p-value = .335).

          Conclusion: The efficacy of preoperative chlorhexidine vaginal painting before cesarean deliveries for reducing febrile morbidity after cesarean deliveries is not statistically different from standard preparation.

References

1. Betran AP, Ye J, Moller A-B, et al. The increasing trend in caesarean section rates:global, regional and national estimates:1990-2014. PLoS One. 2016;11(2):e0148343.
2. Digital NHS Maternity Statistics. NHS Maternity Statistics, England 2017–18. Leeds, UK:Health and Social Care Information Centre;2018.
3. Liabsuetrakul T, Sukmanee J, Thungthong J, et al. Trend of cesarean section rates and correlations with adverse maternal and neonatal outcomes:a secondary analysis of Thai universal coverage scheme data. AJP Rep. 2019;9(4):e328–36.
4. French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev 2004: CD001067.
5. Yokoe DS, Christiansen CL, Johnson R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis. 2001;7:837-41.
6. Yonekura ML. Risk factors for postcesarean endomyometritis. Am J Med 1985;78:177-87.
7. Guldholt I, Espersen T. Maternal febrile morbidity after cesarean section. Acta Obstet Gynecol Scand. 1987;66(8):675-9. doi: 10.3109/00016348709004141.
8. Martens MG, Faro S, Maccato M, et al. Susceptibility of female pelvic pathogens to oral antibiotic agents in patients who develop postpartum endometritis. Am J Obstet Gynecol 1991;164:1383-6.
9. Barwolff S, Sohr D, Geffers C, et al. Reduction of surgical site infections after caesarean delivery using surveillance. J Hosp Infect 2006;64(2):156-61.
10. Watts DH, Hillier SL, Eschenbach DA. Upper genital tract isolates at delivery as predictors of postcesarean infections among women receiving antibiotic prophylaxis. Obstet Gynecol 1991;77(2):287-92.
11. 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.
12. Intrapartum Care. Care of healthy women and their babies during childbirth. London:2014 National Collaborating Centre for Women’s and Children’s Health;2014.
13. American College of Obstetricians and Gynecologists Women's Health Care Physicians; Committee on Gynecologic Practice. Committee opinion no. 571:solutions for surgical preparation of the vagina. Obstet Gynecol. 2013;122(3):718–22.
14. Tuuli MG, Liu J, Stout MJ, et al. A randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med 2016;374:647–55.
15. Ahmed MR, Aref NK, Sayed Ahmed WA, et al. Chlorhexidine vaginal wipes prior to elective cesarean section: does it reduce infectious morbidity? A randomized trial. J Matern Fetal Neonatal Med 2017;30:1484–7.
16. Haas DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before cesarean section for preventing post- operative infections. Cochrane Database Syst Rev 2014;12: CD007892.
17. Eason EL, Sampalis JS, Hemmings R, et al .Povidone-iodine gel vaginal antisepsis for abdominal hysterectomy. Am J Obstet Gyn 1997;176:1011-6.
18. Starr RV, Zurawski J, Ismail M. Preoperative vaginal preparation with povidone–iodine and the risk of post-cesarean endometritis. Obstet Gynecol 2005;105:1024–9.
19. Guzman MA, Prien SD, Blann DW. Post-cesarean related infection and vaginal preparation with povidone–iodine revisited. Prim Care Update for Obstet Gynecol 2002;9:206–9.
20. Aschania M, Mirblouk F, Shakiba M, et al. Preoperative vaginal preparation with povidone-iodine on post-caesarean infectious morbidity. J Obstet Gynaecol 2011;31:400–3.
21. Taha TE, Biggar R, Broadhead RL, et al. Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trial. BMJ 1997;315: 216–19.
22. Haas DM, Morgan S, Contreras K, 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.pub6
23. 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;132(02):371–376.

Published

2021-09-27

How to Cite

1.
Worasatit C. Preoperative Vaginal Painting with Chlorhexidine Before Cesarean Deliveries to Reduce Postoperative Febrile Morbidity : a Randomized Controlled Trial. Reg 4-5 Med J [internet]. 2021 Sep. 27 [cited 2026 Jan. 1];40(3):337-45. available from: https://he02.tci-thaijo.org/index.php/reg45/article/view/253913