Chlorhexidine Vaginal Cleansing Versus Iodine Prior to Cesarean Section and the Rate of Postoperative Maternal Infection: A Randomized Controlled Trial

Abstract

Background: Cesarean delivery is the most common major surgical procedure done by obstetricians. The rate of post-cesarean infectious morbidities is still unacceptably high despite the preoperative skin preparation and antibiotic use. There is evidence that vaginal cleansing prior to cesarean delivery decreases the risk of maternal infectious morbidities. This evidence, however, does not guide to the choice of the optimal antiseptic agent. The objective of the study was to evaluate the efficacy of abdominal and vaginal preparation with chlorhexidine compared to povidone-iodine prior to cesarean delivery in the reduction of post-cesarean infectious morbidities. Methods: This was a single-center randomized controlled trial. Patients undergoing cesarean delivery were randomly assigned to preoperative vaginal and skin preparation with either chlorhexidine or povidone-iodine in addition to the standard preoperative antibiotic prophylaxis. The primary outcome was a composite of postoperative infectious morbidity (fever, endometritis and wound infection) occurring within 30 days of the cesarean delivery. Results: In the period from February 2018 through February 2019, a total of 333 patients were recruited; 159 patients were assigned to chlorhexidine group and 174 to povidone-iodine group. Clinically there was a higher reduction of composite infectious morbidity in the group receiving chlorhexidine preparation when compared to povidone-iodine group; however, this did not reach statistical significance (7 (4.4%) vs. 14 (8.0%) respectively, P = 0.17). Nonetheless, a significant difference could be elicited in less number of clinic follow-up visits with the use of chlorhexidine. Conclusion: The frequency of postpartum infectious morbidity in the entire cohort was lower than expected. This might be the effect of vaginal cleansing (irrespective of the antiseptic used). The use of chlorhexidine or povidone-iodine for combined abdominal and vaginal preparation was not different in reducing post-cesarean infectious morbidities. Clin Infect Immun. 2019;4(2):21-26 doi: https://doi.org/10.14740/cii90