VAGINAL CLEANSING BEFORE EMERGENCY CESAREAN SECTION AND POST-OPERATIVE INFECTIOUS MORBIDITY; CLINICAL TRIAL IN A LOW RESOURCE SETTING

Abstract

Objective: To assess the effectiveness of preoperative vaginal cleansing by looking at the frequency of infectious morbidity after emergency cesarean section. Methodology: A randomized trial of patients, aged 15-45 years, in labour for > 6 hours, was conducted from May 2019 to December 2019 at the Department of Obstetrics and Gynaecology, Women and children Teaching Hospital, Bannu. A total of 400 patients at term gestation were included and assigned to either the interventional; “Vaginal cleaning” or the control; “No vaginal cleaning” groups, based on whether they received vaginal cleansing only or vaginal cleansing as well as abdominal cleansing or not. The development of infectious morbidity was assessed by following all patients up to six weeks postoperatively. Results: The age of the women was in the range of 24-38 years. In interventional versus control groups, the frequency of fever was 8 (6%) versus 17 (11%) (p=0.149), and wound infection was 15 (17.5%) versus 16 (8%) (p=0.851) respectively. There was a significant reduction in the frequency of postoperative endometritis, 4 in the interventional group and 18 in the control group (p=0.00). However, on further analysis, in patients with a history of premature rupture of membranes (PROM), there was a significantly lower incidence of endometritis, fever, and postoperative wound infection in the intervention groups (p=0.00). Conclusions: Using preoperative antiseptic for vaginal cleaning decreases the incidence of postoperative endo­metritis, more significantly in women with a history of PROM in patients undergoing emergency cesarean section.