What is the result of vaginal cleansing with chlorhexidine during labour on maternal and neonatal infections? A systematic review of randomised trials with meta-analysis

Charlotte Bell,Vin Ramkhelawon,Trevor Akister,Laura Hughes,David Lissauer,Amie Wilson

doi:10.1186/s12884-018-1754-9

Abstract

BackgroundInfection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity.The objective of this systematic review is to review the effectiveness of intrapartum vaginal chlorhexidine in the reduction of maternal and neonatal colonisation and infectious morbidity.MethodsSearch strategy – Eight databases were searched for articles published in any language from inception to October 2016.Selection criteria – Randomised controlled trials were included.Data Collection and analysis - Publications were assessed for inclusion. Data were extracted and assessed for risk of bias.Relative risks from individual studies were pooled using a random effects model and the heterogeneity of treatment was evaluated using Chi2 and I2 tests.ResultsEleven randomised controlled trials (n = 20,101) evaluated intrapartum vaginal chlorhexidine interventions. Meta-analysis found no significant differences between the intervention and control groups for any of the four outcomes: maternal or neonatal colonization or infection. The preferred method for chlorhexidine administration was vaginal irrigation.ConclusionsMeta-analysis did not demonstrate improved maternal or neonatal outcomes with intrapartum vaginal chlorhexidine cleansing, however this may be due to the limitations of the available studies. A larger, multicentre randomised controlled trial, powered to accurately evaluate the effect of intrapartum vaginal chlorhexidine cleansing on neonatal outcomes may still be informative; the technique of douching may be the most promising.

Highlights

Infection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity
Between 30 and 40% of neonatal deaths worldwide are caused by infections [3, 4] and 10.7% of maternal deaths (37,285 annually worldwide) are due to sepsis [5]
There was no significant difference in maternal colonization when using vaginal chlorhexidine intrapartum when compared to the control (Fig. 2)

Summary

Introduction

Infection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity. During the process of labour, both mother and fetus are susceptible to infection from a range of vaginal microorganisms including Group B streptococci (GBS), Campylobacter, Enterococcus faecalis, methicillin-resistant Streptococcus aureus, Klebsiellapneumoniae, Escherichia coli and Acinetobaumannii [8]. These organisms can lead to maternal and neonatal mortality and morbidities such as septicaemia, meningitis and pneumonia in the neonate [9] and chorioamnionitis leading to severe pelvic infection in the mother [10]

Methods

Results

Discussion

Conclusion