Vaginal Cleansing Research Articles

Prevention of Post Operative Infection in Obese Women Undergoing Emergency LSCS: Role of Surgical Bundle and Vaginal Cleaning, A Prospective Randomised Interventional Study

Prevention of Post Operative Infection in Obese Women Undergoing Emergency LSCS: Role of Surgical Bundle and Vaginal Cleaning, A Prospective Randomised Interventional Study

Vaginal Cleansing with Povidone Iodine before Elective Caesarean Section at Benha University Hospitals

Vaginal Cleansing with Povidone Iodine before Elective Caesarean Section at Benha University Hospitals

Does vaginal cleansing with iodine decreases infection rate in office hysteroscopy?

To determine whether preoperative vaginal cleansing with iodine-based solution prior to hysteroscopy, reduces postoperative infection rate compared to no vaginal cleansing. A retrospective study at a single tertiary, university affiliated hospital of all individuals who have had an office hysteroscopy. Study group consisted of patients who have had preoperative vaginal cleansing with iodine-based solution and were compared to those who have not. Any procedural related complaints at the 30days following the hysteroscopy were recorded. A total of 505 were available for analysis, 183 in the study group and 322 in the control group. The most common indications for operation were infertility evaluation (33.9% vs. 28.6%) and retained products of conception (33.3% vs. 29.2%), and most common procedures were diagnostic only (49.7% vs. 42.5%) followed by adhesiolysis (12% vs. 14.3%). No statistical differences were noted with regards to postoperative infections, as only one case of pelvic inflammatory disease was noted, in the iodine cleansing group (0.19% for postoperative infection). Our comparative study may suggest that the use of preoperative iodine solution prior to office hysteroscopy does not decrease the postoperative infection rate up to 30days, thus can be avoided.

Preoperative vaginal cleansing with chlorhexidine and cetrimide solution for reduction of postoperative infectious morbidity at a tertiary care center in North India: A prospective cohort study.

To determine the effect of preoperative vaginal cleansing with chlorhexidine and cetrimide solution on postoperative infectious morbidity. This prospective cohort study was conducted over a period of 18 months in the Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Women undergoing cesarean section were alternately allotted to study and control groups. Women with chorioamnionitis, antepartum hemorrhage, rupture of membranes for more than 24 h, and fever in the preoperative period were excluded. The study group received preoperative vaginal cleansing with antiseptic solution (7.5% chlorhexidine w/v and 15% cetrimide w/v); the control group did not receive vaginal cleansing. Both groups were followed for the presence of any infectious morbidity until they were discharged from the hospital. Age, body mass index (calculated as weight in kilograms divided by the square of height in meters), gestational age, and the parity of the women in the study and control groups were comparable (n = 760). The rate of endometritis was lower in the study group, but the difference was not statistically significant (P = 0.054). Post-cesarean febrile morbidity and wound sepsis were significantly lower in the study group (P = 0.017 and P = 0.02, respectively). On subgroup analysis, women in the study group with rupture of the membranes before cesarean delivery had lower wound sepsis and a reduced duration of hospital stay. Women in the study group with emergency cesarean delivery showed a significant reduction in wound sepsis, febrile morbidity, and length of hospital stay. Preoperative vaginal cleansing with chlorhexidine and cetrimide solution before a cesarean section reduces postoperative infectious morbidity.

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

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.

질염 의심 환자에서 플라즈마 활성수 분사법을 이용한 질 세정 효과

플라즈마 활성수(PAW)는 플라즈마에서 발생하는 이온 및 라디칼을 물과 반응시킴으로써 물속에 다양한 활성종이 포함되도록 한 기능성 물이다. 본 연구에서 사용되는 방법은 질염(의심) 환자에서 PAW를 질벽 주름에 분사하고 도포하여 질염 원인균을 세정 후 바로 흡입하여 제거할 수 있는 장점이 있다. 본 임상연구에서는 질염(의심) 환자 총 94명을 대상으로 무작위 배정 후 베타딘 처치와 PAW 분사법을 적용하였으며, 세정 효과는 세정 전과 후의 질 분비물을 이용하여 12종 STD PCR을 수행하였으며, 세정 전 STD PCR 결과가 음성인 피험자를 제외한 대조군(베타딘 처치) 40명과 시험군(PAW 분사) 46명의 결과를 분석하였다. 베타딘 처리군에서는 베타딘 처리 전 PCR 양성 환자가 처리 후에도 모두 양성으로 재확인되어 처치효과가 나타나지 않았으나, PAW 분사군에서는 세정 전과 후의 유의적인 감소율을 보였는데, 그 중에도 Mycoplasma hominis의 경우 세정효과가 30±15.28%, Ureaplasma urealyticum은 25±9.93%, Ureaplasma parvum은 23±8.42%(P0.001), Candida albicans은 28±10.86%로 각각 나타났다. 그러므로 PAW를 이용한 세정만으로도 질염 원인균을 세정하는데 효과가 있음을 보여주었으므로 PAW 분사 세정방법은 화학적 소독제 및 항생제, 항진균제의 새로운 대안으로 임상적 적용이 가능할 것으로 판단되었다.

Reduction of adverse outcomes from cesarean section by surgical-site infection prevention care bundles in maternity.

To reduce average surgical-site infection (SSI) rates to less than 7.5%, as well as other complications by incrementally implementing an SSI prevention care bundle in maternity: (1) ChloraPrep; (2) PICO dressings, performing elective cesarean sections in a main theater rather than a labor ward and warming blankets; (3) vaginal cleansing; and (4) Hibiscrub. In this prospective cohort study, the association between categorical variables was assessed by χ2 tests, temporal trends in the monthly percentage change of SSI were measured using the Joinpoint Regression Program v4.7.0.0. In all, 1682 women (mean age 33.1± 5.2 years) underwent either elective (53.9%) or emergency (46.1%) cesarean section. After a small initial increase (10.0%-11.8%), SSI progressively declined to 4.4% (χ2 = 22.1, P< 0.001), as did sepsis, reoperation or readmission for SSI: from 12.5% to 0.5% (χ2 = 90.1, P< 0.001). The rates of SSI fell progressively with the cumulative introduction care bundle components. The average monthly percentage change was -14.0% (95% confidence interval -21.8% to -5.4%, P= 0.004), and the average SSI rate was kept below 7.5% for the last 12 months of the study. The maternal SSI prevention care bundle is simple and inexpensive; it effectively reduces SSI after a cesarean section and should be offered routinely to women undergoing cesarean section.

Effectiveness of Preoperative Vaginal Cleansing with an Antiseptic Solution among Cesarean Patients

Cesarean section is thought to be one of most common surgical method for delivery of baby, perhaps most frequent procedure by obstetricians. The most important factor after Cesarean section to return to normal life functions and look after new born is Infectious morbidity. Objective: To compare the Effectiveness of preoperative vaginal cleansing with an antiseptic solution among cesarean patients. Methods: This Comparative study was done in department of Obstetrics and Gynecology, Sheikh Zayed Hospital Chandka Medical College Larkana from 20 June 2019 and the last at 19 December 2019.we included 336 patients fulfilling the inclusion criteria. Informed consent was taken. The data were collected on prepared proforma in two groups as A group (intervention group) and B (control group) respectively. Results: Study includes 336 patients with mean age of 26.29±4.7 and 26.52±5.9 years, divided in two groups 168 in each group A and B respectively. Out of 336, 14(4.2%) developed endometritis, 8(2.4%) developed wound infection and 16(4.8%) developed fever. The composite morbidity was 11.3%; with 26.3% of group A and 73.6% of group B. Conclusions: This study showed that the use of 10% Povidone iodine was significant in reducing post op morbidity. Cleansing of vagina with an antiseptic solution is easy intervention before cesarean section

Effectiveness of Chlorhexidine vaginal cleansing in reducing post-caesarean endometritis at two tertiary hospitals in Enugu, Nigeria: A randomized controlled trial.

Despite the use of prophylactic antibiotics during Caesarean delivery, post-Caesarean surgical site infection (SSI) and endometritis still often complicate the puerperal period. We speculated that the use of vaginal cleansing with chlorhexidine solution would serve as an adjunct to prophylactic antibiotics in reducing the menace of post-caesarean endometritis and indeed found a significant reduction.

Pre-operative Vs. Post-operative Vaginal Cleansing with Povidone-iodine and Post-caesarean Infectious Morbidity: A Randomized Controlled Study.

Post-caesarean maternal infectious morbidity is still a big challenge despite prophylactic antibiotics use and other modalities adopted to prevent it. Pre-operative or post-operative vaginal cleansing with povidone-iodine may have effect on post-caesarean maternal infectious morbidity. The aim of this study was to compare the effectiveness of pre-operative vs. post-operative vaginal cleansing with povidone-iodine in reducing post-caesarean maternal infectious morbidities in a teaching hospital, South East Nigeria. This was a randomized controlled trial involving 244 pregnant women who underwent elective or emergency lower segment caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Recruited patients were randomized into two groups: Group 1 had pre-operative vaginal cleansing with 5% povidone-iodine, whereas group 2 had post-operative vaginal cleansing with 5% povidone-iodine. Post-operatively, patients were monitored for clinical symptoms and signs of endometritis, wound infection, and pyrexia daily till discharge and at 2 weeks post-partum visit. Both groups received same post-operative care. Data were analysed using Statistical Package for Social Sciences (IBM SPSS) software (version 20, Chicago, IL, USA). Continuous variables were presented as mean and standard deviation (mean ± 2SD), whereas categorical variables were presented as numbers, frequencies, and percentages. The t-test was used for comparison between groups for quantitative variables, whereas the χ2 test was used to compare categorical variables. Relative risk and 95% confidence interval were calculated for outcome measures. P-value<0.05 was considered significant. The overall infectious morbidity rate was 14.3% (34/239) in all the study participants. The rate was 1.7% (4/239) among women in the pre-operative vaginal cleansing group and 12.6% (30/239) among women in the post-operative vaginal cleansing group. This was statistically significant [(P < 0.05); relative risk (RR) 0.13, 95% confidence interval (CI) 0.05-0.36]. Endometritis occurred in 13/239 (5.4%) women with 0.8% in the pre-operative group and 4.6% in the post-operative vaginal cleansing group. This was also statistically significant (P = 0.009; RR 0.18, 95% CI 0.04-0.78). Wound infection occurred in 11/239 (4.6%) women with 0.8% in the pre-operative group and 3.8% in the post-operative vaginal cleansing group (P = 0.032; RR 0.22, 95% CI 0.05-0.98). Pyrexia occurred in 10/239 (4.2%) women with 0 (0%) in the pre-operative group and 4.2% in the post-operative vaginal cleansing group. This was also statistically significant (P = 0.0007; RR 0.01, 95% CI 0.007-0.16). These were commoners among women with ruptured foetal membranes (P =0.001; RR 0.22, CI 0.08-0.61) and those who had emergency caesarean delivery (P=0.0001; RR 0.14, CI 0.05-0.37). Pre-operative vaginal cleansing with povidone-iodine is more effective in the reduction of composite post-caesarean maternal infectious morbidity compared with immediate post-operative vaginal cleansing with povidone-iodine, especially in women with ruptured foetal membranes and those who had emergency caesarean section.

Implementation of an evidence-based bundle to reduce surgical site infection after caesarean section – Review of the interventions

BackgroundSurgical site infection (SSI) is the most common complication post caesarean section (CS) with a significant impact on women and health services. A bundle approach incorporating previously studied individual interventions has shown increased reductions in SSI. AimTo assess compliance with a SSI intervention bundle and to examine readmission rates for SSI. MethodsA retrospective audit of women who underwent CS at a regional hospital in Queensland, Australia pre-intervention (February 2015-January 2017) and post-intervention (February 2018-December 2020). ResultsThere was good compliance with vaginal cleansing (27.7% vs 84.8%), chlorhexidine skin preparation (90.4% vs 98.4%), BMI-based antibiotic dose adjustment (48.8% vs 74.3%), and Alexis retractor use (9.9% vs 66%), pre and post-implementation periods respectively. There was a reduction in documented hair shaving (2.1% vs 0.5%). There was a trend towards less admission for SSI, a trend that could have been even better had there not been an increasing number of women with high BMI over the years. Fewer cases needed return to theatre post-implementation. Endometritis rates were unchanged. ConclusionsGood compliance can be achieved with good collaboration. There was a reduction in admission rates for SSI. Larger prospective studies are needed to further examine these findings.

A randomized controlled trial of an oral probiotic to reduce antepartum group B Streptococcus colonization and gastrointestinal symptoms

Probiotics have been suggested as a strategy to reduce antenatal group B Streptococcus colonization. Although probiotics are known to improve gastrointestinal symptoms, this has not been studied during pregnancy. This study aimed to evaluate the efficacy of a probiotic to reduce: (1) standard-of-care antenatal group B Streptococcus colonization and colony counts and (2) gastrointestinal symptoms of pregnancy. In a double-blind fashion, 109 healthy adult pregnant people were randomized to Florajen3 probiotic or placebo capsules once daily from 28 weeks' gestation until labor onset. Baseline vaginal and rectal study swabs for group B Streptococcus colony-forming units and microbiome analysis were collected at 28 and 36 weeks' gestation. Standard-of-care vaginal to rectal group B Streptococcus swabs were collected from all participants at 36 weeks' gestation and determined the need for intrapartum antibiotic prophylaxis. Data collection included solicitation of adverse events, demographic information, Antepartum Gastrointestinal Symptom Assessment score, yogurt ingestion, sexual activity, and vaginal cleaning practices. A total of 83 participants completed the study to 36 weeks' gestation with no adverse events. Standard-of-care group B Streptococcus colonization was 20.4% in the control group and 15.4% in probiotic group participants (-5%; P=.73). The relative risk for positive standard-of-care vaginal-rectal group B Streptococcus colonization was 1.33 (95% confidence interval, 0.5-3.40) times higher in the control group than in the probiotic group (P=.55). There were no differences in median vaginal (P=.16) or rectal (P=.20) group B streptococcus colony-forming units at baseline or at 36 weeks (vaginal P>.999; rectal P=.56). Antepartum Gastrointestinal Symptom Assessment scores were similar at baseline (P=.19), but significantly decreased in probiotic group participants at 36 weeks (P=.02). No covariates significantly altered group B Streptococcus colonization. Significantly more Florajen3 bacteria components were recovered from the vaginal-rectal samples of probiotic group participants (32%; P=.04) compared with controls. The findings of this study provided insufficient evidence for the clinical application of the Florajen3 probiotic intervention to reduce standard-of-care vaginal-rectal group B Streptococcus colonization. The prevalence of group B Streptococcus was lower than expected in the study population, and intervention adherence was poor. Probiotic bacteria colonization of the genitourinary tract occurred more in intervention group participants than in controls and significantly reduced gastrointestinal symptoms of pregnancy.

Factors affecting the use of antibiotics and antiseptics to prevent maternal infection at birth: A global mixed-methods systematic review

Over 10% of maternal deaths annually are due to sepsis. Prophylactic antibiotics and antiseptic agents are critical interventions to prevent maternal peripartum infections. We conducted a mixed-method systematic review to better understand factors affecting the use of prophylactic antibiotics and antiseptic agents to prevent peripartum infections. We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health, Global Index Medicus, and Maternity and Infant Care for studies published between 1 January 1990 and 27 May 2022. We included primary qualitative, quantitative, and mixed-methods studies that focused on women, families, and healthcare providers' perceptions and experiences of prophylactic antibiotic and antiseptics during labour and birth in health facilities. There were no language restrictions. We used a thematic synthesis approach for qualitative evidence and GRADE-CERQual approach for assessing confidence in these review findings. Quantitative study results were mapped to the qualitative findings and reported narratively. We included 19 studies (5 qualitative, 12 quantitative and 2 mixed-methods studies), 16 relating to antibiotics, 2 to antiseptic use, and 1 study to both antibiotic and antiseptic use. Most related to providers' perspectives and were conducted in high-income countries. Key themes on factors affecting antibiotic use were providers' beliefs about benefits and harms, perceptions of women's risk of infection, regimen preferences and clinical decision-making processes. Studies on antiseptic use explored women's perceptions of vaginal cleansing, and provider's beliefs about benefits and the usefulness of guidelines. We identified a range of factors affecting how providers use prophylactic antibiotics at birth, which can undermine implementation of clinical guidelines. There were insufficient data for low-resource settings, women's perspectives, and regarding use of antiseptics, highlighting the need for further research in these areas. Implications for practice include that interventions to improve prophylactic antibiotic use should take account of local environments and perceived infection risk and ensure contextually relevant guidance.

Vaginal preparation with different antiseptic solutions before cesarean section for preventing postoperative infections: A systematic review and network meta-analysis.

We aimed to investigate the effect of various vaginal wash solutions on reducing risks of post-cesarean endometritis, wound infections, fever, and hospital stay duration. Scopus, Web of Science, PubMed, and Cochrane Library were searched for randomized clinical trials that compared different vaginal wash solutions to each other or to "no vaginal cleaning"; without restriction on the age of parturients or site where trials were conducted. We analyzed this frequentist network meta-analysis using the netmeta package in R software version 4.1.2; synthesized data as mean difference or risk ratio with their 95% confidence intervals. Our network meta-analysis included 29 RCTs with a total sample size of 9311 women undergoing CS. Regarding post-cesarean endometritis, we found that povidone-iodine had the highest significant risk reduction compared to "no vaginal cleaning" (RR=0.08, 95% CI [0.01, 0.69]). While regarding post-cesarean reduction of wound infection, fever, and hospital stay duration, we found that chlorhexidine 4% (RR=0.17, 95% CI [0.05, 0.65]), saline 0.9% (RR=0.12, 95% CI [0.03; 0.48]), and saline 0.9% (MD=-1.29, 95% CI [-2.18; -0.39]), respectively, had the highest significant risk reduction compared to "no vaginal cleaning." Vaginal wash solutions were associated with a significant reduction of post-cesarean endometritis, wound infection, fever, and hospital stay duration. Since povidone-iodine had the highest significant reduction of post-cesarean endometritis, we recommend setting povidone-iodine as the standard practice as pre cesarean vaginal wash solution; consistent practice guidelines of Enhanced Recovery After Surgery (ERAS).

Incidence and risk factors for surgical wound complications in women with body mass index >30 kg/m2 following cesarean delivery: a secondary analysis

BACKGROUNDSurgical wound complications are common and occur in between 3% and 12% of obese women after cesarean delivery. An understanding of the risk factors for wound complications may inform potential areas for clinical care improvement.OBJECTIVEThis study aimed to identify the incidence and predictors of surgical wound complications in obese women after cesarean delivery.STUDY DESIGNThis was a secondary analysis of the ADding negative pRESSure to improve healING, or DRESSING, randomized controlled trial conducted at 4 maternity hospitals in Australia. A total of 2035 women with a prepregnancy body mass index ≥30 kg/m2 undergoing cesarean delivery were included. Data were collected between October 2015 and December 2019 using self-reporting of signs and symptoms, the research nurses’ direct observation of the surgical site, and medical records. Independent blinded outcome assessors ascertained wound outcomes on the basis of self-reported data and medical records. Multivariable logistic regression models were used to identify independent risk factors for wound complications and surgical wound dehiscence. The 30-day cumulative incidence of wound complications and surgical wound dehiscence was calculated.RESULTSOf the 2035 women, 317 (15.6%) developed a wound complication, whereas 211 (10.4%) developed surgical wound dehiscence. The predictors of a wound complication included 1 previous cesarean delivery (odds ratio, 1.41; 95% confidence interval, 1.05–1.90; P=.02) and ruptured membranes >12 hours (odds ratio, 1.69; 95% confidence interval, 1.08–2.66; P=.02). The odds of developing any wound complication decreased by 45% with vaginal cleansing (odds ratio, 0.55; 95% confidence interval, 0.42–0.72; P<.001) and by 59% for low transverse incision (odds ratio, 0.41; 95% confidence interval, 0.18–0.94; P=.04). The predictors of surgical wound dehiscence included 1 previous cesarean delivery (odds ratio, 1.62; 95% confidence interval, 1.14–2.31; P=.008) and ruptured membranes >12 hours (odds ratio, 1.85; 95% confidence interval, 1.10–3.12; P=.02). The odds of developing surgical wound dehiscence decreased by 50% for vaginal cleansing (odds ratio, 0.50; 95% confidence interval, 0.36–0.69; P<.001) and by 42% for using a double-layer uterine closure (odds ratio, 0.58; 95% confidence interval, 0.35–0.97; P=.04).CONCLUSIONWound complications and surgical wound dehiscence in this population are high. The predictors observed herein would assist in identifying high-risk women. Such information may guide patient-centered decision-making in the planning of surgical births and individualized postoperative care.

Effect of Pre-elective Cesarean Section Vaginal Cleansing using Povidone-Iodine versus Chlorhexidine on the Incidence of Post-Cesarean Infections

Effect of Pre-elective Cesarean Section Vaginal Cleansing using Povidone-Iodine versus Chlorhexidine on the Incidence of Post-Cesarean Infections

Clinical aspects of oocyte retrieval and embryo transfer: tips and tricks for the novice and the expert.

Oocyte retrieval (ovum pick-up) and embryo transfer (ET) are essential steps in in-vitro fertilization and intracytoplasmic sperm injection and over the years, the two procedures were developed in order to improve the clinical outcome. Many suggestions were proposed and applied before, during and after oocyte retrieval such as timing of HCG trigger, pre-operative pelvic scan, vaginal cleansing, type of anesthesia, type and gauge of aspiration needles, aspiration pressure, follicle flushing, and the need for prophylactic antibiotics. Similarly, many steps were suggested and implemented before, during and after ET including patient's position, type of anesthesia/analgesia, dummy (mock) ET, ultrasound-guidance, HCG injection in the uterine cavity, use of relaxing agents, full bladder, removal of the cervical mucus, flushing the cervix with culture medium, type of ET catheter, embryo loading techniques, site of embryo deposition, the use of adherence compounds, as well as bed rest after ET. Complications were also reported with oocyte retrieval and ET. The aim of this review is to evaluate the current practice of these two procedures in the light of available evidence.

Incidence and predictors of surgical site infection in women who are obese and give birth by elective caesarean section: A secondary analysis.

Surgical site infection (SSI) after a caesarean section is of concern (CS) is of concern to both clinicians and women themselves. The aim of this study is to identify the cumulative incidence and predictors of SSI in women who are obese and give birth by elective CS. The method used was planned secondary analysis of data from women with a pre-pregnancy body mass index (BMI) ≥30kg/m2 giving birth by elective CS in a multicentre randomised controlled trial of a prophylactic closed-incision negative pressure wound therapy dressing. Data were collected from medical records, direct observations of the surgical site and self-reported signs and symptoms from October 2015 to December 2019. The Centers for Disease Control and Prevention definition was used to identify SSI. Women were followed up once in hospital just before discharge and then weekly for fourweeks after discharge. Blinded outcome assessors determined SSI. After the cumulative incidence of SSI was calculated, multiple variable logistic regression models were used to identify independent risk factors for SSI. SSI incidence in 1459 women was 8.4% (122/1459). Multiple variable-adjusted odds ratios (OR) for SSI were BMI ≥40kg/m2 (OR 1.55, 95% confidence interval (CI) 1.30-1.86) as compared to BMI 30-34.9 0kg/m2 , ≥2 previous pregnancies (OR 1.38, 95% CI 1.00-1.80) as compared to no previous pregnancies and pre-CS vaginal cleansing (OR 0.55, 95% CI 0.33-0.99). Our findings may inform preoperative counselling and shared decision-making regarding planned elective CS for women with pre-pregnancy BMI ≥30kg/m2 .

Exploring the Vaginal Microbiome and Intravaginal Practices in Postmenopausal Women.

Evidence suggests that intravaginal practices (IVPs) women use to cleanse their vagina or enhance sexual pleasure may be associated with unhealthy changes in the vaginal microbiome (VM). However, the effects of these practices in postmenopausal women are unknown. The objective of this pilot study was to characterize the VM communities of postmenopausal women, identify types and frequency of IVPs, and explore associations between the VM and IVPs in postmenopausal women. We analyzed the VM data of 21 postmenopausal women in Atlanta, Georgia, from vaginal swabs collected at a routine gynecological visit. 16S rRNA gene sequencing in the V3-V4 region was used to characterize the VM. In addition, we described the IVPs of these women, identified by using our newly developed instrument: the Vaginal Cleansing Practices Questionnaire. The associations between the VM and IVPs were explored by comparing the alpha diversities, beta diversities, and the relative abundances at both the community level and individual genus level. The most abundant known bacterial genus found in the VM samples was Lactobacillus (35.7%), followed by Prevotella (21.4%). Eleven women (52%) reported using at least one type of IVP since menopause. The most common type of IVP was soap and water to clean inside the vagina. The use of IVPs was not associated with any alpha diversity metric, including Shannon index, inverse Simpson index, and Chao1 index; beta diversity metric, including Bray-Curtis and Jaccard distances; nor relative abundances at the community and individual genus level. Sociodemographic factors were also not associated with any alpha diversity metric. Clinicians must assess IVPs and other vaginal and sexual hygiene practices of women of all ages to educate and promote healthy behaviors. More than half of the postmenopausal women in this pilot study use IVPs. Understanding the reasoning behind participants' use of IVPs and their perceptions of the possible effects of these practices will require further research. Although the small sample did not show associations with the VM, more extensive studies are warranted.

A cohort study on safety for oocyte retrieval in IVF using the same 20G needle for local analgesia and retrieval. Vaginal cleaning did not add to the safety of the procedure

Aim of study: What is the effectiveness and safety of using a 20G single lumen needle (SLN) for both applying local analgesia (LA) in the vaginal vault and ovarian capsule and oocyte retrieval (OR) using a simple syringe? And will thoroughly cleaning (TC) of the vagina before reducing the risk of the puncture procedure? Using a thin SLN has been postulated to jeopardize cumulus oocyte complexes (COC). Further applying LA in the same needle without retracting the needle before OR has been claimed to harm oocyte development. Also, many clinics extensively clean the vagina before OR. Methods: We performed a retrospective cohort study including 4983 women. 877 underwent no cleaning (nonTC) of the vagina and 4106 underwent TC using NaCl. All had OR with a 20G SLN attached to a syringe for local anaesthesia and egg collection. The treatments were done in one centre during the period from January 2016 to June 2019. We studied women undergoing IVF treatment aged 18–45 years. Women had either thoroughly vaginal cleaning before OR or no cleaning depending on the physicians preferences. All women had LA using Citanest Dental Octapressin 2ml. placed in the vaginal vault in the direction of the intended puncture including in the ovarian capsule. Therefore, only one puncture was needed in both sides, left and right. All punctures were hereafter followed by OR using the same 20G SLN. Aspiration was done by a 20ml syringe handled manually by the physician. All women underwent a conventional antagonist protocol with FSH stimulation and Ovitrelle 250IU for induction or Mild Stimulation using Tamoxifen, FSH and Ovitrelle. Outcome measurement were bleeding measured by the necessity of applying compression after the puncture or infection observed up to 1 month. Results: Baseline characteristics including age, BMI and type of stimulation were comparable between the groups. In the nonTC group no infections, bleedings or abscesses were found. In the TC group there were 1 abscess observed. Intact COC was similar in the two groups as well as pregnancy rates. Conclusion: During OR in ART the use of a 20G SLN using the same needle for LA and hereafter, without changing needle in the puncture channel, continue with the egg collection (EC) is simple and safe. In this situation TC is not necessary before puncture, making the procedure more patients friendly. In women undergoing oocyte retrieval for IVF, we found the use of a 20G SLN for both applying LA and retrieving COC safe, effective and simple. Additional TC of the vagina before puncture did not add more to the safety of the procedure.