Preoperative Vaginal Preparation Research Articles

Assessment of Pre-operative Vaginal Preparation for Laparoscopic Hysterectomy.

Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of three vaginal preparation solutions (10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine). This was a prospective randomized controlled trial in an academic community hospital. Patients were ≥ 18 years old and scheduled for laparoscopic hysterectomy for benign and malignant indications. Fifty patients were identified and randomized into each arm. Prior to surgery, the surgical team prepared the vaginal field using 10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine, according to group assignment. Cultures were collected from the vagina after initial preparation, prior to the colpotomy, and on surfaces of the uterine manipulator. Bacterial count from the baseline vaginal fornix/cervical canal cultures did not differ significantly among the three groups. There was a difference in bacterial count among the second cervical canal/vaginal fornix cultures (p < 0.01), with the Povidone-iodine arm demonstrating the highest level of growth of cultures (93.8%), followed by 2% Chlorhexidine (47.4%), and 4% Chlorhexidine (20%). There was no difference in growth on the uterine manipulator handle and no difference in vaginal itching or burning was found across the three arms postoperatively. Bacterial growth prior to colpotomy was the lowest with 4% Chlorhexidine followed by 2% Chlorhexidine, the Povidone-iodine group exhibited the highest bacterial growth. There was no difference in moderate to severe vaginal itching or burning. This showed that 4% Chlorhexidine is superior in reducing bacterial growth when used in laparoscopic hysterectomy.

Preoperative Vaginal Preparation with Chlorhexidine Gluconate to Reduce Post-Cesarean Delivery Infectious Morbidity

Preoperative Vaginal Preparation with Chlorhexidine Gluconate to Reduce Post-Cesarean Delivery Infectious Morbidity

Vaginal preparation with povidone-iodine or chlorhexidine before hysterectomy: a propensity score matched analysis

Antiseptic vaginal preparation is recommended before gynecologic surgery; however, there is a lack of data regarding the effectiveness of different agents. To compare rates of postoperative infectious complications and hospital utilization with preoperative vaginal preparation using povidone-iodine or chlorhexidine before hysterectomy. This was a retrospective analysis of patients who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was postoperative infectious complications (including urinary tract infection, surgical site infections involving superficial, deep, or organ space tissues, or cellulitis) within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of.005 was performed to create cohorts that had vaginal preparation with either povidone-iodine or chlorhexidine and did not differ in observable characteristics. We compared the rates of infectious morbidity and hospital utilization (emergency department visits, readmission, reoperation) in the matched cohorts. In the statewide collaborative, there were 18,184 patients who received povidone-iodine and 3018 who received chlorhexidine. After propensity score matching of 2935 pairs, the povidone-iodine and chlorhexidine groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach. Povidone-iodine was associated with a lower rate of infectious morbidity (3.0% vs 4.3%; P=.01), urinary tract infection (1.1% vs 1.7%; P=.03) and emergency department visits (7.9% vs 9.7%; P=.01) than with chlorhexidine. There were nonsignificant trends of lower rates of surgical site infection (2.0% vs 2.7%; P=.07) and reoperation (1.6% vs 2.1%; P=.18). This propensity score matched analysis provides evidence that povidone-iodine is preferable to chlorhexidine for vaginal preparation before hysterectomy because of lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were approximately 1%, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.

Multidisciplinary Approach to Process Improvement and Surgical Site Infection Prevention

Background In preparation for abdominal hysterectomy (HYST) procedures, antiseptic agents are used to cleanse incision sites and surrounding skin, including the vaginal vault and perineum. These areas harbor high microbial counts which can contaminate the surgical site, if not prepared appropriately. The study aims to assess the impact of perioperative staff education on vaginal skin preparation compliance and HYST surgical site infection (SSI) outcomes. Methods Adherence to best practice standards for pre-operative vaginal preparation was assessed through in-person observations of varying perioperative staff. Opportunities for improvement were targeted through implementation of a 3-tier education plan. HYST SSIs outcomes during and after execution of education were observed. Results Observations revealed variations in practice among perioperative staff members. The need to highlight and demonstrate current best practice standards, as well as validate improved execution were addressed in the 3-tier education plan for current staff and those on boarded during study execution. HYST SSI rate was reduced by 83%, from 11.11% in December 2018 to 1.89% in August 2019. Conclusions This study found that targeted process improvement, including continuing education for employees and plan for continuity with new employees, improved execution of best practice standards and positively impacted SSI outcomes.

17 Postoperative infectious morbidity after hysterectomy: A propensity-matched analysis comparing vaginal preparation with povidone iodine versus chlorhexidine

To compare rates of infectious morbidity and hospital utilization with preoperative vaginal preparation using povidone iodine (PI) or chlorhexidine (CHX) prior to hysterectomy. This was a retrospective analysis of women who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was post-operative infectious morbidity which included urinary tract infection and surgical site infection (SSI) involving superficial, deep, or organ space tissues within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of 0.005 was performed to create cohorts that had vaginal preparation with either PI or CHX and did not differ in observable characteristics. We compared rates of infectious morbidity as well as hospital utilization (reoperation, readmission, and ED visits) in the matched cohorts. In the statewide collaborative, there were 18,184 patients who received PI and 3,018 who received CHX. After propensity score matching of 2935 pairs, the PI and CHX groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach (Table 1). PI was associated with a lower rate of infectious morbidity when compared to the CHX group (3.0% vs 4.3%, P = 0.008; Figure 1). There were significantly lower rates of urinary tract infection (1.1% vs 1.7%, P = 0.034) and emergency department visits (7.9% vs 9.7%, P = 0.013) in the PI group when compared with CHX. There were non-significant trends of lower rates of SSI (2.0% vs 2.7%, P = 0.071) and reoperation (1.6% vs 2.1%, P = 0.174) in the PI group when compared with CHX. This propensity score-matched analysis provides evidence that povidone iodine is preferable to chlorhexidine for vaginal preparation prior to hysterectomy due to lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were relatively small, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.

Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. This is an update of a Cochrane Review first published in 2010 and subsequently updated in 2012, twice in 2014, in 2017 and 2018. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We also assessed the side effects of vaginal cleansing solutions to determine adverse events associated with the intervention. We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (7 July 2019), and reference lists of retrieved studies. We included randomized controlled trials (RCTs) and quasi-RCTs assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. Cluster-RCTs were eligible for inclusion, but we did not identify any. We excluded trials that utilized vaginal preparation during labor or that did not use antibiotic surgical prophylaxis. We also excluded any trials using a cross-over design. We included trials published in abstract form only if sufficient information was present in the abstract on methods and outcomes to analyze. At least three of the review authors independently assessed eligibility of the studies. Two review authors were assigned to extract study characteristics, quality assessments, and data from eligible studies. We included 21 trials, reporting results for 7038 women evaluating the effects of vaginal cleansing (17 using povidone-iodine, 3 chlorhexidine, 1 benzalkonium chloride) on post-cesarean infectious morbidity. Trials used vaginal preparations administered by sponge sticks, douches, or soaked gauze wipes. The control groups were typically no vaginal preparation (17 trials) or the use of a saline vaginal preparation (4 trials). One trial did not report on any outcomes of interest. Trials were performed in 10 different countries (Saudi Arabia, Pakistan, Iran, Thailand, Turkey, USA, Egypt, UK, Kenya and India). The overall risk of bias was low for areas of attrition, reporting, and other bias. About half of the trials had low risk of selection bias, with most of the remainder rated as unclear. Due to lack of blinding, we rated performance bias as high risk in nearly one-third of the trials, low risk in one-third, and unclear in one-third. Vaginal preparation with antiseptic solution immediately before cesarean delivery probably reduces the incidence of post-cesarean endometritis from 7.1% in control groups to 3.1% in vaginal cleansing groups (average risk ratio (aRR) 0.41, 95% confidence interval (CI) 0.29 to 0.58; 20 trials, 6918 women; moderate-certainty evidence). This reduction in endometritis was seen for both iodine-based solutions and chlorhexidine-based solutions. Risks of postoperative fever and postoperative wound infection are also probably reduced by vaginal antiseptic preparation (fever: aRR 0.64, 0.50 to 0.82; 16 trials, 6163 women; and wound infection: RR 0.62, 95% CI 0.50 to 0.77; 18 trials, 6385 women; both moderate-certainty evidence). Two trials found that there may be a lower risk of a composite outcome of wound complication or endometritis in women receiving preoperative vaginal preparation (RR 0.46, 95% CI 0.26 to 0.82; 2 trials, 499 women; low-certainty evidence). No adverse effects were reported with either the povidone-iodine or chlorhexidine vaginal cleansing. Subgroup analysis suggested a greater effect with vaginal preparations for those women in labour versus those not in labour for four out of five outcomes examined (post-cesarean endometritis; postoperative fever; postoperative wound infection; composite wound complication or endometritis). This apparent difference needs to be investigated further in future trials. We did not observe any subgroup differences between women with ruptured membranes and women with intact membranes. Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis, postoperative fever, and postoperative wound infection. Subgroup analysis found that these benefits were typically present whether iodine-based or chlorhexidine-based solutions were used and when women were in labor before the cesarean. The suggested benefit in women in labor needs further investigation in future trials. There was moderate-certainty evidence using GRADE for all reported outcomes, with downgrading decisions based on limitations in study design or imprecision. As a simple intervention, providers may consider implementing preoperative vaginal cleansing with povidone-iodine or chlorhexidine before performing cesarean deliveries. Future research on this intervention being incorporated into bundles of care plans for women receiving cesarean delivery will be needed.

Transvaginal laparoscopic cholecystectomy combined with myomectomy(NOTES)

Summary: Recently, we successfully performed transvaginal laparoscopic cholecystectomy combined with hysteromyomectomy (NOTES) for a 42-year-old female patient. It is reported that this operation is the first hard-mirror combined NOTES operation reported in China. The patient, Ms. Chen, was diagnosed with multiple gallstones, chronic cholecystitis and multiple uterine leiomyomas. Patients hope that one-off surgery can solve two problems and reduce the pain. The patient was operated on August 8, 2018. Firstly, the gynecologist enters the abdominal cavity via vagina and establishes pneumoperitoneum. Then the hepatobiliary and pancreatic surgeon completes laparoscopic cholecystectomy. Finally, the gynecologist performs hysteromyomectomy. The operation was successful with a total length of 2.5 hours and bleeding of about 50 ml. Ms. Chen recovered well and was discharged on the second day. Return to the hospital a week ago, all indicators were normal. Transvaginal suture into abdominal cavity and vaginal incision is a very mature routine technique in reproductive gynecology. The suture of vaginal puncture hole is relatively simple. Preoperative vaginal preparation can effectively control abdominal infection. All these provide theoretical basis and technical support for our transvaginal NOTES operation. As a new minimally invasive technique, NOTES has the advantage of no scar in abdomen compared with laparotomy and traditional laparoscopic surgery, thus avoiding incision infection, surgical scar and postoperative hernia. At the same time, it can reduce postoperative pain, shorten hospitalization time, and reduce postoperative abdominal adhesion. We use hard mirror to perform NOTES operation without any incision in the abdomen. In the future, NOTES operation and 3D laparoscopic technique will be the development trend of minimally invasive surgery.

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.

Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. This is an update of a Cochrane review first published in 2010 and subsequently updated in 2012, and twice in 2014. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We also assessed the side effects of vaginal cleansing solutions to determine adverse events associated with the intervention. We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (10 July 2017), and reference lists of retrieved studies. We included randomized trials and one quasi-randomized trial assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. Cluster-randomized trials were eligible for inclusion but none were identified. We excluded trials that utilized vaginal preparation during labor or that did not use antibiotic surgical prophylaxis. We also excluded any trials using a cross-over design. At least three of the review authors independently assessed eligibility of the studies. Two review authors were assigned to extract study characteristics, quality assessments, and data from eligible studies. We included 11 trials reporting results for 3403 women evaluating the effects of vaginal cleansing (eight using povidone-iodine, two chlorhexidine, one benzalkonium chloride) on post-cesarean infectious morbidity. Additionally, some trials used vaginal preparations using sponge sticks, douches, or soaked gauze wipes. The control groups were typically no vaginal preparation (eight trials) or the use of a saline vaginal preparation (three trials). The risk of bias in the studies reduced our confidence in the results for endometritis outcomes.Vaginal preparation with antiseptic solution immediately before cesarean delivery probably reduces the incidence of post-cesarean endometritis from 8.7% in control groups to 3.8% in vaginal cleansing groups (average risk ratio (RR) 0.36, 95% confidence interval (CI) 0.20 to 0.63, 10 trials, 3283 women, moderate quality of evidence). Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used. Risks of postoperative fever and postoperative wound infection may be slightly lowered by antiseptic preparation, but the confidence intervals around the effects for both outcomes are consistent with a large reduction in risk and no difference between groups (fever: RR 0.87 (0.72 to 1.05; wound infection: RR 0.74 (95% CI 0.49 to 1.11), both moderate-quality evidence). Two trials reported a lower risk of a composite outcome of wound complication or endometritis in women receiving preoperative vaginal preparation (RR 0.46, 95% CI 0.26 to 0.82, two trials, 499 women, moderate-quality evidence). No adverse effects were reported with either the povidone-iodine or chlorhexidine vaginal cleansing. Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis. Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used.The quality of the evidence using GRADE was moderate for all reported outcomes. We downgraded the outcome of post-cesarean endometritis and composite of wound complications or endometritis for risk of bias and postoperative fever and postoperative wound infections for wide CIs.As a simple, generally inexpensive intervention, providers may consider implementing preoperative vaginal cleansing with povidone-iodine or chlorhexidine before performing cesarean deliveries.

Preoperative Vaginal Preparation for Prevention of Post-Cesarean Endometritis [22L

INTRODUCTION: Endometritis complicates 6%–27% cesarean deliveries (CD). A recent meta-analysis showed a reduction in endometritis with vaginal cleansing prior to CD (4.5% versus 8.8%). Our study examines the proportions of endometritis from two time periods–prior to and after the implementation of vaginal preparation prior to CD at one hospital. We aim to see the effect shown in research in clinical practice. METHODS: A retrospective chart review of 356 women undergoing cesarean delivery prior to and after the policy change. After implementation of the vaginal preparation protocol, a policy of administration of 400 μg of buccal misoprostol for postpartum hemorrhage prophylaxis was instituted so this was recorded. Odds ratios (OR) and 95% confidence interval (CI) of endometritis diagnosed by ICD code or 2+ symptoms were calculated. RESULTS: The rate of endometritis was 3.8% in the pre-policy period and 15.2% post-policy, OR 4.5 (95% CI 1.7–11.8). Notably the frequency of fever was 4.5% pre-policy compared with 22.2% post-policy. When the rates of endometritis with those given misoprostol were excluded the rates were 3.8% pre-policy and 6.7% post-policy, OR 1.8 (95% CI 0.5–6.6). CONCLUSION: When comparing rates of endometritis after instituting a vaginal preparation protocol we found a paradoxical increase in the rate of endometritis. However, this could be driven by the increased rate of fevers associated with misoprostol prophylaxis. When this was accounted for, there was a non-significant increase. Confounding factors may lead to important differences from randomized studies and are important to assess when evaluating practice change.

Retraction notice to “Evaluation of the risk of postcesarean endometritis with preoperative vaginal preparation with povidone–iodine: A randomized controlled study” [Middle East Fertil. Soc. J. 20/4 (2015) 246–250

Retraction notice to “Evaluation of the risk of postcesarean endometritis with preoperative vaginal preparation with povidone–iodine: A randomized controlled study” [Middle East Fertil. Soc. J. 20/4 (2015) 246–250

Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis.

To assess the efficacy of vaginal cleansing before cesarean delivery in reducing postoperative endometritis. MEDLINE, Ovid, EMBASE, Scopus, Clinicaltrials.gov, and Cochrane Library were searched from their inception to January 2017. Selection criteria included all randomized controlled trials comparing vaginal cleansing (ie, intervention group) with a control group (ie, either placebo or no intervention) in women undergoing cesarean delivery. Any method of vaginal cleansing with any type of antiseptic solution was included. The primary outcome was the incidence of endometritis. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% CI. Sixteen trials (4,837 women) on vaginal cleansing immediately before cesarean delivery were identified as relevant and included in the review. In most of the included studies, 10% povidone-iodine was used as an intervention. The most common way to perform the vaginal cleansing was the use of a sponge stick for approximately 30 seconds. Women who received vaginal cleansing before cesarean delivery had a significantly lower incidence of endometritis (4.5% compared with 8.8%; RR 0.52, 95% CI 0.37-0.72; 15 studies, 4,726 participants) and of postoperative fever (9.4% compared with 14.9%; RR 0.65, 95% CI 0.50-0.86; 11 studies, 4,098 participants) compared with the control group. In the planned subgroup analyses, the reduction in the incidence of endometritis with vaginal cleansing was limited to women in labor before cesarean delivery (8.1% compared with 13.8%; RR 0.52, 95% CI 0.28-0.97; four studies, 440 participants) or those with ruptured membranes (4.3% compared with 20.1%; RR 0.23, 95% CI 0.10-0.52; three studies, 272 participants). Vaginal cleansing immediately before cesarean delivery in women in labor and in women with ruptured membranes reduces the risk of postoperative endometritis. Because it is generally inexpensive and a simple intervention, we recommend preoperative vaginal preparation before cesarean delivery in these women with sponge stick preparation of povidone-iodine 10% for at least 30 seconds. More data are needed to assess whether this intervention may be also useful for cesarean deliveries performed in women not in labor and for those without ruptured membranes. PROSPERO International prospective register of systematic reviews, https://www.crd.york.ac.uk/PROSPERO/, CRD42017054843.

Antibacterial solution for cesarean delivery preoperative vaginal preparation, prevention of postoperative infection

Antibacterial solution for cesarean delivery preoperative vaginal preparation, prevention of postoperative infection

RETRACTED: Evaluation of the risk of postcesarean endometritis with preoperative vaginal preparation with povidone–iodine: A randomized controlled study

Objective To investigate the effect of preoperative vaginal preparation with povidone–iodine as a preventive intervention against postcesarean endometritis and wound infection. Design Randomized controlled study. Setting Suzan Mubarak University Hospital, Egypt & Aramco Hospital, Saudia Arabia. Patients 400 women were to undergononemergent cesarean delivery. Subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone–iodine solution. All subjects received prophylactic antibiotic preoperatively. Interventions Each subject’s postoperative course was reviewed for development of febrile morbidity (temperature > 38.0 °C), endometritis (temperature > 38.4 °C accompanied by fundal tenderness occurring beyond the first postoperative day, in the absence of evidence of other infection), and wound infection. Results Postcesarean endometritis occurred in 7.0% of subjects who received a preoperative vaginal preparation and 14.5% of controls (P < .05). There was no measurable effect of a vaginal scrub on the development of postoperative fever or wound infection. The adjusted odds ratio for developing endometritis after a vaginal preparation was 0.44 (95% confidence interval (CI) 0.193–0.997). Multivariate analysis showed an increased risk of developing endometritis in association with severe anemia (adjusted OR 4.26, 95% Cl 1.568–11.582), use of intrapartum internal monitors (adjusted OR 2.84, 95% Cl 1.311–6.136), or history of antenatal genitourinary infection (adjusted OR 2.9, 95% CI 1.265–6.596). Conclusion Preoperative vaginal scrub with povidone–iodine decreases the incidence of postcesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection.

Preferences in cesarean delivery surgical technique: a survey of maternal–fetal medicine fellows

Objective: Our goal was to (1) describe self-reported cesarean delivery (CD) surgical techniques of Maternal–Fetal Medicine (MFM) fellows and (2) determine whether preferences were congruent with recommendations using US Preventive Services Task Force (USPSTF) criteria.Methods: MFM fellows were queried regarding their preferred CD technique via online survey. Preferences were compared to evidence-based recommendations using standard recommendation language and quality of evidence as outlined by the USPSTF. Categorical variables were compared by Chi-square analysis or Fisher’s exact test, with p < 0.05 considered statistically significant.Results: Of 233 active MFM fellows in August 2012, 167 completed the survey, resulting in a response rate of 71%. Statistically significant differences of preferences were noted when stratified by year in fellowship (blunt tip needles), gender (thromboprophylaxis, skin incision, fascial extension, uterine closure suture) and geographic region of fellowship (fascial extension, skin closure). CD techniques preferred by MFM fellows were congruent with recommendations designated as high or moderate level of certainty with regard to prophylactic antibiotics, uterine incision extension, uterine atony prevention and placenta removal, while incongruent with regards to pre-operative vaginal preparation and blunt needle preference.Conclusion: Among MFM fellow respondents, variation exists in preferred CD technique and vis-à-vis evidence-based recommendations.

Preoperative vaginal preparation with povidone-iodine on post-caesarean infectious morbidity

SummaryThe commonest complication associated with caesarean section is infection. The aim of this study is to investigate the effect of vaginal preparation with povidone-iodine on post-caesarean infection. In this clinical trial, 568 patients were selected for two groups: a treatment group and a control group, each with 284 patients. A vaginal scrub was performed before the routine abdominal scrub, with two 4 × 4 cm sponge sticks saturated with povidone-iodine solution, rotated in the vagina for about 30 s. In the control group, only the abdominal scrub was performed. Patients received a single dose of prophylactic antibiotics, and were reviewed for 6 weeks to look for predefined variables. Post-caesarean endometritis occurred less frequently in the treatment group than in the control group (2.5% vs 1.4%). There was no significant difference for febrile morbidity and wound infection in the two groups. The adjusted odds ratio for endometritis after vaginal preparation was 0.03 (95% CI: 0.008–0.7). Vaginal preparation with povidone-iodine may decrease the risk of post-caesarean endometritis.

Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery

To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity. Retrospective, longitudinal cohort study. Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery. All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008. Register data were collected prospectively using doctors' forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors. Infectious morbidity within 6-8 weeks postoperatively. No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery. Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.

Preoperative vaginal preparation with baby shampoo compared with povidone-iodine before gynecologic procedures

Study objective The objective of this study was to compare the postoperative infection rates between patients receiving either povidone-iodine (PI) or baby shampoo vaginal preparations before gynecologic surgery. Design Cohort study (Canadian Task Force classification II-2). Setting University referral center for gynecologic endoscopy. Patients All patients underwent minimally invasive gynecologic surgery including hysteroscopy or laparoscopy. Interventions The agents used for vaginal preparation were either baby shampoo in a 1:1 dilution with sterile normal saline solution or PI 7.5% scrub solution. Measurements and main results Charts were reviewed for evidence of infection within 30 days of surgery (symptoms of urinary tract infection, abdominal or vaginal wound infections, temperature > 100.4° F, and fungal or bacterial vaginitis). A total of 249 cases were collected; 96 subjects underwent surgery before the change to baby shampoo and 153 subjects after. Both groups were well matched for the types of surgery performed, age, risk factors for postoperative infections, and the postoperative diagnosis. The infection rates were 14/96 (14.6%) with PI preparation versus 18/153 (11.8%) with baby shampoo (p = .52). Conclusion Baby shampoo should be studied as an alternative to PI because it is a nonirritating, inexpensive mild detergent. This preliminary study suggests that baby shampoo is as effective as PI in preventing postoperative infection.

Preoperative Vaginal Preparation With Baby Shampoo Compared With Povidone-Iodine

Preoperative Vaginal Preparation With Baby Shampoo Compared With Povidone-Iodine

Preoperative Vaginal Preparation With Povidone-Iodine and the Risk of Postcesarean Endometritis

© 2005 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Preoperative Vaginal Preparation With Povidone-Iodine and the Risk of Postcesarean Endometritis

Obstetrics & Gynecology: October 2005 - Volume 106 - Issue 4 - p 866 doi: 10.1097/01.AOG.0000181684.34253.dc