Vaginal Preparation Prior to Planned Cesarean Delivery to Reduce Postpartum Endometritis: A Quality Improvement Study [ID: 1378331

Abstract

INTRODUCTION: Infection prophylaxis is an important part of perioperative care. Studies have demonstrated that incorporation of pre-cesarean vaginal preparation reduces postoperative rates of endometritis in laboring patients or those with ruptured membranes. Our study aimed to identify whether vaginal preparation decreases the risk of postpartum endometritis among scheduled cesarean deliveries. METHODS: We retrospectively reviewed all pregnant people with scheduled cesarean deliveries in one urban, teaching hospital between April 2018 and November 2020. Deliveries were excluded if they were laboring, had ruptured membranes prior to surgery, had known iodine allergy, or had other intraoperative complications. Deliveries were divided into three groups based on vaginal preparation protocol implementation: preimplementation (April 2018 to March 2019), implementation (April 2019 to November 2019), and postimplementation (December 2019 to November 2020). Only deliveries in the preimplementation versus postimplementation group were compared given implementation learning curve. Descriptive and inferential statistics were computed; χ2 or Fisher’s exact test was used to assess differences in rates of endometritis or other postpartum complications. RESULTS: Overall, 320 scheduled cesarean deliveries were included (N=162 preimplementation; N=158 postimplementation). Rates of endometritis was not different between groups (1.2% versus 2.5% postimplementation; P=.44). Similarly, postpartum complication rates for fever (1.2% versus 3.8% postimplementation, P=.17), wound infection (3.7% versus 3.2% postimplementation, P=.79), sepsis (0% versus 0.6% postimplementation, P=.49), and 30-day readmission unrelated to preeclampsia (3.7% versus 3.3% postimplementation, P=.12) were not different between groups. CONCLUSION: While there was no reduction in postpartum endometritis in patients undergoing planned cesarean delivery, universal implementation may still be a reasonable intervention given its low cost and known benefit in laboring patients or those with ruptured membranes.