Postoperative Vaginal Cleansing with Chlorhexidine Gluconate Versus Povidone-Iodine for Prevention of Post-Caesarean Endometritis: A Randomized Controlled Trial.
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Keywords
Post Operative, vaginal cleansing, Povidone Iodine, Chlorhexidine Gluconate
Abstract
Background: Maternal infectious morbidity is a common complication of caesarean section. Despite prophylactic antibiotics, endometritis following caesarean section is still a big challenge. Preoperative vaginal cleansing with povidone may not be feasible in emergencies necessitating its use postoperatively, and comparing its efficacy with cheaper and readily available solutions. The aim is to compare the effectiveness of post-operative vaginal cleansing with povidone-iodine(PI) versus chlorhexidine gluconate (CHG) in reducing post-caesarean endometritis.
Methodology: This was a single-blinded randomized controlled trial. One hundred and twenty participants had post-operative vaginal cleansing with Povidone-iodine and one hundred and nineteen with Chlorhexidine gluconate, with attrition of 2 and 3 participants from the PI and CHG groups, respectively. Both groups received prophylactic antibiotics. They were reviewed for endometritis daily till discharge or up to 7 days. Data was analysed with SPSS.
Result: The study showed that post-caesarean vaginal cleansing with either agent did not detect any case of endometritis. Although the duration of ruptured membranes prior to surgery was statistically significant, with a mean of 19.26±44.4, 8.7±10.9 for PI and CHG, respectively, p-0.038; RR-0.627-21.561. Post-operative fever was recorded in the PI group (0.02%) but was not statistically significant. p=2.773; RR=1.667; 95%CI (0.624-3.957). No adverse effect was reported with either agent, Anaphlactic reaction=0, and local irritation was 1.67% with P=0.498
Conclusion: Post-operative vaginal cleansing with CHG was not superior to PI in preventing the occurrence of post-Caesarean endometritis. Although CHG had a better side effect profile when compared with PI, the findings were not statistically significant. CHG may be recommended for use following result from multicentre studies.
References
2. Betran AP, Ye J, Moller A, Zhang J, Gulmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates:1990-2014. PLos One. 2016; 11(2):e0148343.
3. Agboeze J, Onoh RC, Umeora OU, Ezeonu PO, Ukaegbe C, Onyebuchi AK, et al. Microbiological pattern of post cesarean wound infection at Federal Teaching Hospital, Abakaliki. Afr. J Med Health Sci. 2013; 12:99-102.
4. Mutihir JT, Utoo B T. Postpartum maternal morbidity in Jos, North-Central Nigeria. Niger J Clin. Pract. 2011; 14:38-42
5. Halder A, Vijayselvi R, JoseR. Changing perspectives of infectious causes of maternal mortality. J Turk GerGynecol Assoc. 2015; 16(4): 208–213.
6. Morton VH, Wilson A, Hewitt C, Weckesser A, Farmer N, Lissauer et al.Chlorhexidine vaginal preparation versus standard treatment at caesarean section to reduce endometritis and prevent sepsis—a feasibility study protocol (the PREPS trial) Pilot Feasibility Stud. 2018; 4: 84.
7. Oslen MA, Butler AM, Willers DM, Gross GA, Devkota P, Fraser VJ. Risk factors for endometritis following low transverse caesarean section. Infect Control HospEpidemiol. 2010; 31(1):69-77.
8. Ugadu IO. Preoperative vaginal cleansing versus postcaesarean vaginal cleansing with povidone iodine for prevention of postoperative maternal infectious morbidity at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki: a randomized controlled trial. 2019.(unpublished).
9. Conroy k, Koenig AF, Yu Y, Courtney A, Lee HJ, Norwitz ER. Infectious Morbidity After Cesarean Delivery: 10 Strategies to Reduce Risk. Rev Obstet Gynecol. 2012; 5(2): 69–77.
10. Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. Cochrane Database of Systematic Reviews.2015; 2:1465-1858
11. Zuarez-easton S, Zafran N, Garmi G, Salim R. Post cesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women’s Health .2017:9 81–88
12. Nasir IA, Babayo A, Emeribe AU, Sani NO. Surveillance for Antibiotic Resistance in Nigeria: Challenges and Possible Solutions. Trends in Medical Research .2015; 10: 106-113.
13. Haas DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before caesarean section for preventing postoperative infections. Cochrane Database Syst Rev.2014; 12:CD007892.
14. WHO recommendation on vaginal cleansing with povidone-iodine immediately before caesarean section. The WHO Reproductive Health Library; Geneva: World Health Organization.2015.
15. Culligan PJ, Kubi K, Murphy M, Blackwell L, Snyder J. A randomized controlled trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. Am. J. Obstet. Gynecol.2005; 192:422-425.
16. Lim KS, Kam PCA.” Chlorhexidine-pharmacology and clinical application.” Anesthesia and Intensive Care.2008; 36(4):502-512.
17. Zhong B. How to Calculate Sample Size in Randomized Controlled Trial. J Thorac Dis. 2009; 1(1): 51–54.
18. Birchenall K, Vanes N, Engineer N. Vaginal cleansing following caesarean section: Are postoperative complications reduced? BJOG. 2014; 121:86.
19. Mwangi K, Oyeike J, Kinuthia J. Effect Of Preoperative Vaginal Cleansing with Povidone Iodine On Post-Caesarean Maternal Infections At Kenyatta National Hospital; A Randomized Controlled Trial. University Of Nairobi Department Of Obstetrics And Gynaecology.2013;1-57.
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