Does vaginal preparation with povidone–iodine prior to caesarean delivery reduce the risk of endometritis? A randomized controlled trial

Abstract

Objective: The purpose of the present study was to determine whether the vaginal preparation with povidone–iodine prior to caesarean delivery decreased the incidence of postpartum endometritis. Methods: The present study was a prospective randomized controlled trial in which subjects received a vaginal preparation with povidone–iodine solution immediately prior to caesarean delivery or received no vaginal preparation. The primary outcome measure was the rate of postpartum endometritis. Results: A significant decrease in post-caesarean endometritis was noted in the group that received the povidone–iodine vaginal preparation (n = 334) compared with the control group (n = 336) [6.9 vs. 11.6%; RR = 1.69; 95% CI = 1.03–2.76]. No statistically significant differences in the incidence of endometritis were noted between the experimental and control groups among women who were not in labor at the time of the caesarean delivery [9.2 vs. 8.6%; RR = 1.05; 95% CI = 0.58–1.90], and no differences were found between groups when women with ruptured membranes were excluded from the analysis [9.6 vs. 6.7%; RR = 1.39; 95% CI = 0.78–2.47]. Conclusions: Vaginal preparation with povidone–iodine solution immediately prior to a caesarean delivery reduces the risk of post-operative endometritis. This preemptive measure was only found to be beneficial in women whose membranes had ruptured and those who were in labor prior to caesarean surgery.