Vaginal Preparation Research Articles

Postpartum readmission after unscheduled cesarean delivery in patients with class 3 obesity.

Identify risk factors for postpartum readmission in class 3 obese patients undergoing unscheduled cesarean deliveries. Retrospective cohort study of patients with BMI ≥ 40 kg/m2 undergoing unscheduled cesarean delivery from 2017-2020 comparing patients with and without postpartum readmission (unexpected admission, emergency room/overnight observation visit, unscheduled outpatient visit, or ambulatory surgery within 30 days). Medical history, operative data, and postpartum outcomes were compared between the cohorts. "The electronic medical record was queried to identify cesarean deliveries documented as 'unscheduled'". 255 of 1273 identified patients (20.0%) had a postpartum readmission. Median BMI was similar between the cohorts (44.2 kg/m2, IQR [41.8, 47.9] vs. 44.8 kg/m2 [42.0, 48.9], p= 0.066). Readmitted patients were more likely to have a history of smoking during or prior to pregnancy (p= 0.046). A sub-group exploratory analysis excluding outpatient and emergency room visits demonstrated higher rates of type II diabetes mellitus in patient's with postpartum readmission (11.5% vs 4.6%, p= 0.030). Patients with readmission in comparison to those without readmissions were less likely to receive cefazolin prophylaxis (78.0% vs 84.3%, p= 0.014) in comparison to gentamicin/clindamycin prophylaxis. Patients with readmission were less likely to have had vaginal preparation (56.9% vs 64.3%, p= 0.027). On multivariable logistic regression analysis, smoking history (OR 1.44, 95% CI 1.06-1.96, p= 0.0220) and hypertensive disease (OR 1.57, 95% CI 1.18-2.09, p 0.002) were associated with readmission. Cefazolin preoperative prophylaxis (OR 0.59, 95% CI 0.41-0.84, p= 0.004) and vaginal sterile preparation (OR 0.72, 95% CI 0.54- 0.95, p= 0.022) were associated with decreased risk of readmission. In class 3 obese patients, a history of smoking and a diagnosis of hypertensive disease associate with increased risk of postpartum readmission. Perioperative antibiotic prophylaxis with cefazolin along with vaginal sterile preparation associate with decreased risk of postpartum readmission.

Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe.

Rates of HIV acquisition remain high among adolescent girls and young women (AGYW) in sub-Saharan Africa. We explored South African, Ugandan, and Zimbabwean AGYW's experiences in a crossover trial of two HIV prevention products: Daily oral pre-exposure prophylaxis pills and a monthly dapivirine vaginal ring. A subset of participants (n = 25) across all sites completed up to three serial in-depth interviews (SIDIs). The SIDIs explored barriers to product use, coping strategies, and the resulting outcomes. Coded textual data were analyzed using a product acceptability conceptual framework. Participants in the SIDIs described managing the array of challenges they encountered through formal adherence support, strategic product disclosure, and personally adapted strategies. For both products, perceived discreetness of the product and decision-making around disclosure was an important component of participants' narratives. Participants tailored their coping strategies based on available personal resources (e.g., cell phone alarms for PrEP reminders, social support through disclosure) or study provided resources (e.g., encouragement from staff, adherence groups). Notably, challenges participants encountered with each product during the crossover period helped inform product selection during the choice period. Our findings suggest that-even in a context where AGYW have access to several options for HIV prevention-challenges to consistent product use remain, but accessible support mechanisms and informed choice can help mitigate these challenges. Enacting that choice may also empower AGYW to reach their short and long-term life goals-including for HIV prevention. (NCT03593655, 20th July 2018).

Prospective Study on Prevention of Post-Caesarean Endometritis by Vaginal Preparation with Povidone Iodine 1% Preoperatively in a Rural Tertiary Hospital in Central India

Prospective Study on Prevention of Post-Caesarean Endometritis by Vaginal Preparation with Povidone Iodine 1% Preoperatively in a Rural Tertiary Hospital in Central India

Outpatient elective induction of labour at 39 weeks’ gestation (HOME INDUCTION): an open-label, randomised, controlled, phase III, non-inferiority trial

The increased demand for induction of labour (IOL) at 39 weeks' gestation in normal-risk nulliparous patients creates significant logistical challenges for busy maternity units. A potential innovation is commencing induction by means of outpatient cervical ripening, using either a vaginal prostaglandin preparation (Propess) or an osmotic cervical dilator (Dilapan-S). A Phase III, open label, single centre non-inferiority trial (EudraCT number 2019-004697-25) randomised healthy nulliparous women who chose elective IOL at 39 weeks to one of three methods of initial cervical ripening, specifically 12h of Dilapan-S(D12), 24h of Dilapan-S(D24), or 24h of Propess(P24) between November 2020 and July 2023. After initial administration of the IOL agent in the hospital, participants returned home for 12 or 24h, before readmission to complete delivery. The primary outcome was vaginal delivery achieved at any time, and this was compared in a non-inferiority analysis of Dilapan-S compared to Propess, within a 10% non-inferiority margin. Secondary outcomes included pairwise comparisons for each induction agent, and a range of logistical factors, such as time to delivery, the need for an additional cervical ripening agent, and length of hospital stay. Of the 327 women randomised at 38 weeks, 271 (83%) completed the induction intervention. The D24 and P24 groups showed similarly high rates of vaginal delivery, 75% and 76% respectively. D12 had a lower vaginal delivery rate of 64% and consequently the overall comparison of Dilapan-S to Propess did not demonstrate non-inferiority (difference=-6%, 95% CI=-17%, 5%) because the lower 95% CI exceeded the-10% threshold of non-inferiority. The majority of participants across all groups were delivered by any means within 72h of starting the induction process, inclusive of time spent at home (89% of the D24 group, 98% of the D12 group, 95% of the P24 group). There were no differences in rates of adverse events between groups. There were similarly high vaginal delivery rates for D24 and P24, with at least 75% of patients successfully delivering vaginally following outpatient cervical ripening, with no significant adverse maternal or neonatal outcomes. The Rotunda Foundation, Medicem Technology s.r.o.

Efficacy of Hormonal and Non-hormonal Vaginal Gel Preparations on Female Sexual Satisfaction Index in Postmenopausal Women with Sexual Dysfunction Syndrome

Efficacy of Hormonal and Non-hormonal Vaginal Gel Preparations on Female Sexual Satisfaction Index in Postmenopausal Women with Sexual Dysfunction Syndrome

Impact of chlorhexidine and povidone-iodine antiseptic solutions on the cervicovaginal microenvironment during laparoscopic hysterectomies: a pilot study

The use of chlorhexidine gluconate (CHG) as surgical preparation solution has been advocated due to reduced bacterial loads compared with povidone-iodine (PI). We aimed to investigate changes to the vaginal microenvironment among patients who had laparoscopic hysterectomy and were surgically prepped using 4% CHG compared to 7.5% PI. Premenopausal women who underwent laparoscopic hysterectomy for benign conditions and were prepped with either CHG or PI per surgeon’s choice were enrolled. Vaginal swabs and cervicovaginal lavages were collected prior to vaginal preparation and at 4–6 week post-operative visits for microbiome (α and β diversity, bacterial relative abundances, vaginal pH) and immune marker analyses (protein profiles and concentrations). Antimicrobial activity of clinical CHG and PI formulations were tested in vitro using minimal inhibitory and bactericidal concentration assays. Between February 2021 and June 2022, 41 patients were enrolled. Seven patients either withdrew consent or met exclusion criteria for vaginal bleeding. Thirty-four patients had pre-operative samples collected; 13 patients were lost to follow-up. A total of 21 patients with longitudinal samples of pre- and post-operative collection contributed to this study: 13 in the CHG group and 8 in the PI group. Prior to surgery, 75–77% of women in both groups exhibited Lactobacillus dominance. PI did not change overall vaginal microbiome profiles; however, CHG impacted Lactobacillus iners-dominant profiles, shifting to other lactobacilli (50%) or dysbiotic anaerobes (33%). Lactobacillus crispatus-dominant profiles, which are optimal for vaginal health, were not impacted by either antiseptic solution. In vitro assays further confirmed higher susceptibility of L. iners to CHG solution compared to other vaginal lactobacilli species. Pro-inflammatory cytokines or chemokines were not increased in the CHG or PI group. Our study suggests that CHG does not increase the rate of post-operative vaginal dysbiosis, or genital inflammation compared to PI. Species-specific effects of CHG on vaginal lactobacilli and its clinical impact require further investigation.

Vaginal antiseptic preparation at the time of hysterectomy: a systematic review and meta-analysis

Vaginal antiseptic preparation at the time of hysterectomy: a systematic review and meta-analysis

Presurgical vaginal preparation regimens for antisepsis in gynecologic surgery: a systematic review and meta-analysis

Presurgical vaginal preparation regimens for antisepsis in gynecologic surgery: a systematic review and meta-analysis

A Study to Assess the Effectiveness of Video Assisted Teaching Programme on Knowledge regarding Normal Vaginal Delivery Preparation among Primigravida Antenatal Mothers at Selected Hospital of Indore City

A Study to Assess the Effectiveness of Video Assisted Teaching Programme on Knowledge regarding Normal Vaginal Delivery Preparation among Primigravida Antenatal Mothers at Selected Hospital of Indore City

970 The effectiveness of a CD bundle with vaginal preparation, Cefazolin and Azithromycin in reducing infections

970 The effectiveness of a CD bundle with vaginal preparation, Cefazolin and Azithromycin in reducing infections

Effectiveness of preoperative vaginal preparation with povidone-iodine before total laparoscopic hysterectomy

Effectiveness of preoperative vaginal preparation with povidone-iodine before total laparoscopic hysterectomy

977. Impact of Chlorhexidine (CHG) vaginal preparation compared to betadine on rates of Total abdominal Hysterectomy (TAH) Surgical Site Infections (SSI)

Abstract Background American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control (CDC) both recommend vaginal cleaning prior to surgery as part of hysterectomy SSI prevention. However, there is no clear guidance on preference of agent. Povidone-iodine is FDA approved for vaginal prep, but 4% chlorhexidine gluconate (CHG) is often used by surgeons as an acceptable alternative (off label) as there is some limited data to show improved bacterial counts with CHG. Methods In 2020, our healthcare system implemented a vaginal hysterectomy SSI bundle consisting of preoperative CHG bathing day of surgery, alcohol containing skin preparation, vaginal preparation with betadine, or CHG per surgeon preference and adherence to system guidelines on preoperative antibiotics. Additional bundle components for open procedures included use of a separate closing tray, re-gowning/re-gloving and re-draping prior to closing. The TAH Bundle was not mandatory but highly recommended. Compliance was monitored and feedback was given to key stakeholders monthly. In the third quarter 2022, the bundle was modified to make CHG the preferred agent for vaginal prep. We performed a retrospective study of patients who underwent inpatient and outpatient TAH between 1/1/2020 to 12/31/2022 comparing rates of SSIs between patients who received CHG vs betadine for vaginal preparation. Results 7327 TAH procedures were performed during the study period with rate of 1.24 TAH SSI per 100 procedures(Table 1). The rate of TAH SSI was 35% lower in the group receiving CHG vaginal prep compared to those who received betadine (IRR 0.65, p = 0.06). SSI rates and compliance with all components of the bundle varied by facility. The decrease associated with CHG vaginal prep compared to betadine was primarily in the group where all other bundle elements were followed (IRR 0.53, p=0.02) (Table 2). Conclusion In aggregate, use of CHG for vaginal prep was associated with a trend towards lower SSI. Use of CHG vaginal prep was associated with higher compliance with other bundle elements and facilities with higher compliance generally had lower SSI rates supporting bundle concept in SSI prevention. Limitations of this study include that individual patient level factors/case complexity, facility size were not taken into consideration. Disclosures All Authors: No reported disclosures

10421 Impact of Chlorhexidine Gluconate Versus Povidone-Iodine on the Vaginal Microenvironment as Vaginal Operative Preparation

10421 Impact of Chlorhexidine Gluconate Versus Povidone-Iodine on the Vaginal Microenvironment as Vaginal Operative Preparation

A systematic review of randomised clinical trials - The safety of vaginal hormones and selective estrogen receptor modulators for the treatment of genitourinary menopausal symptoms in breast cancer survivors.

Therapies utilised in breast cancer management have been found to induce or worsen the genitourinary symptoms of menopause (GSM), a group of physical symptoms associated with the systemic loss of estrogen. These symptoms are often undertreated due to concerns surrounding cancer recurrence, especially when considering treatments with possible pro-estrogenic effects. As breast cancer prognosis continues to improve, clinicians are increasingly focussing on managing these symptoms amongst survivors. This systematic review primarily aimed to determine the risk of breast cancer recurrence amongst survivors using vaginal hormones and selective estrogen receptor modulator therapies recommended for use in GSM in the United Kingdom amongst currently published randomised clinical trials (RCTs). The secondary aim was to determine whether these RCTs demonstrated a significant rise in serum estrogen levels following the use of these therapies. A literature search revealed three RCTs suitable for assessment, two evaluating vaginal estrogen and one evaluating vaginal DHEA treatment. Our review determined that amongst published RCTs, no studies have aimed to assess for breast cancer recurrence; however among the studies observing for serious adverse effects of vaginal estrogen preparations, none have reported an increased incidence. Furthermore, these studies did not report a persistent or significant increase in serum estrogen levels following the use of vaginal estrogen products and low concentration (3.25mg/day) DHEA gel. Larger RCTs studying commonly used vaginal preparations and selective estrogen receptor modulator treatments for GSM over longer follow-up periods will be vital to better assess the risk of breast cancer recurrence in survivors receiving these treatments.

Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal-Approach Hysterectomy at a Midwestern Teaching Hospital.

Accrediting organizations, third-party payers, and patients review the surgical site infection (SSI) rates of health care organizations. Infection preventionists collaborate with perioperative personnel to decrease SSI rates; they also monitor and report SSI information to national organizations. The standard infection ratio is a comparison of the observed number of SSIs to the predicted number of SSIs based on national benchmark data. Leaders of a midwestern teaching hospital convened an interdisciplinary team (eg, surgeons, perioperative leaders, infection preventionists) to address a standard infection ratio after hysterectomies that was greater than 1.0. The team reviewed national guidelines and published articles on decreasing SSIs (including recommendations for vaginal preparation) before developing and implementing a hysterectomy-specific bundle for SSI prevention. The rate of SSIs decreased 68% after the implementation of the bundle. Perioperative personnel at this facility continue to use the bundle and infection preventionists monitor and report compliance with the bundle's elements.

Impact of converting from povidone iodine to chlorhexidine gluconate for vaginal preparation prior to hysterectomy

While vaginal preparation prior to hysterectomies to reduce the risk of contamination by vaginal flora is standard, there is no consensus on the appropriate choice of antisepsis agent. The aim of this study was to evaluate whether the conversion from povidone-iodine (PI) to chlorhexidine gluconate (CHG) would reduce surgical site infection (SSI) rates and improve standardized infection ratios (SIR). A quality improvement process was implemented to educate all providers, trainees, and staff followed by wide-spread conversion to CHG vaginal preparation prior to all hysterectomies starting on June 1, 2021. The SSI rates and SIRs were compared between the preintervention and postintervention periods. There was no significant change in SSI rate or SIR from the preintervention to the postintervention period, indicating that CHG is noninferior to PI. The SSI rate was 1.53% preintervention compared to 1.57% post, and the SIR was 1.976 and 2.049, respectively. While our data suggests that the conversion from PI to CHG for vaginal prep alone is insufficient to reduce SSI rates and SIRs, it is noninferior and should be considered as part of a larger preventative bundle.

P-768 A network meta-analysis yields new insights on the efficacy of different progestogen regimens for luteal support in fresh embryo in vitro fertilization

Abstract Study question How do seven progestogen regimens rank in their efficacy for achieving clinical pregnancy when used as luteal support in women undergoing fresh embryo transfer? Summary answer Given as luteal support and based on clinical pregnancy rate, intramuscular progesterone was most effective, followed by oral dydrogesterone and then micronized vaginal progesterone gel. What is known already A large number of randomized controlled trials (RCTs) have compared fresh in vitro fertilisation cycle luteal support with progestogens. A number of systematic reviews and conventional meta-analyses have likewise been published. A network meta-analysis integrates direct and indirect comparisons between treatments in a single analysis, and allows the ranking of treatments and the estimation of heterogeneity in both the effect of any given treatment and the inconsistency (‘incoherence') in the evidence from different pairs of treatments. Network meta-analyses can thus increase the precision and robustness of inferences from the literature on treatment effect estimates. Study design, size, duration A literature search was performed using BIOSIS, Embase, and MEDLINE and supplemented with manual searches to identify RCTs reporting the efficacy of progestogen regimens in luteal support during fresh embryo transfer. A single network meta-analysis was used to compare progestogen regimens, combining both direct and indirect evidence across the selected studies using the R package ‘netmeta’ and fixed and random effects models. The analysis was repeated and confirmed using SAS. Participants/materials, setting, methods Peer-reviewed full publications that compared individual progestogens (either with placebo or another progestogen) were included. Studies were excluded if they included frozen embryo transfers, used human chorionic gonadotropin or formulations not currently available for the indication, or if they did not report at least clinical pregnancy rate. Two authors (EK, QW) individually reviewed papers to collect data. Where doses differed between studies for an individual progestogen the doses were noted and the results combined. Main results and the role of chance Among studies from 1987–2022, 35 RCTs met the inclusion criteria, comprising 17,955 observations of 7 treatments plus placebo and resulting in 43 pairwise comparisons for the network meta-analysis of clinical pregnancy rate (the primary outcome). Based on the random effects model, the top three regimens versus placebo were intramuscular (IM) progesterone, Duphaston® (oral dydrogesterone), and Crinone® (micronized progesterone vaginal gel) (see Figure). Compared with placebo, only the top 3 ranking compounds had confidence intervals that excluded zero, with a risk difference to placebo (95% confidence interval) of 0.08 (0.01-0.14) for IM progesterone and 0.07 (0.01-0.13) for both Duphaston® and Crinone®. The P-score (fixed, random) ranking for the compounds was: IM progesterone 0.77, 0.79; Duphaston® 0.78, 0.69; Crinone® 0.65, 0.65; Cyclogest® (vaginal micronized progesterone) 0.58, 0.60; Endometrin® (vaginal micronized progesterone) 0.52, 0.54; Prolutex® (subcutaneous progesterone) 0.31, 0.36; Utrogestan® (vaginal micronized progesterone) 0.34, 0.31; and placebo 0.05, 0.06. Ranking was confirmed by SUCRA score (surface under the cumulative ranking curve). Studies were thoroughly reviewed to ensure similarity assumption. Homogeneity and consistency of the network were investigated and fulfilled. Exclusion of placebo-controlled studies did not impact the overall results or rankings. Limitations, reasons for caution Treatment duration was assumed identical across arms in each study and therefore was not included in this analysis. Most studies were single-centre with a small sample size. Methodological rigor was heterogenous between trials. Direct comparisons with placebo were only available for the top three compounds. Wider implications of the findings Three progestogen regimens showed a positive effect on clinical pregnancy rate versus placebo. Frequently used vaginal preparations do not lead the efficacy league table when the available direct and indirect comparative evidence is collated. Relevant efficacy differences likely exist between the available progesterone regimens. Trial registration number n/a

P-550 Comparison of progesterone levels according to the type of vaginal micronized progesterone used for luteal phase support in artificial-cycles for endometrial preparation in embryo transfer.

Abstract Study question Are there differences in the ongoing pregnancy rate (OPR) using Cyclogest® versus Progeffik® at a dose of 800 mg daily as luteal phase support? Summary answer The administration of Cyclogest® as luteal phase support shows higher ongoing pregnancy rates (OPR) in a cycle of hormone replacement therapy (HRT) with own oocytes What is known already The importance of serum progesterone levels around the time of embryo transfer in patients undergoing FET under artificial endometrial preparation has been well established; some studies have shown that optimizing serum progesterone levels on the day before, leads to an improvement in live birth rates (LBR). However, to date, no study has examined which vaginal preparation reports better serum progesterone levels and its impact on OPR. Study design, size, duration This prospective randomized clinical trial was performed between September 2019 and June 2022 and enrolled 490 patients scheduled for cryopreserved ET after an artificial endometrial preparation cycle with estradiol valerate and micronized vaginal progesterone. They were divided into two groups, those who used Progeffik® and others with Cyclogest® total dose of 800mg. SPLs were measured the day before (P + 4), the day of the transfer (P + 5) and the day of BHCG (P + 19) and compared the OPR. Participants/materials, setting, methods Patients between 18-40 years of age with BMI <30 and triple-layer endometrium > 7,5mm underwent transfer of one blastocysts with own oocytes. The study was carried out in the assisted human reproduction unit of the Virgen de Valme University Hospital (Seville). Ethical approval was granted and formed consent was obtained. The primary endpoint is to assess which vaginal progesterone preparation gives better ongoing pregnancy rates. Main results and the role of chance The 484 patients were randomized (1:1) into two groups. Progeffik was administered to 149 patient and Cuyclogest to 335 patient. The characteristics of the patients were comparable between groups with similar causes of fertility and type of IVF. Regarding the results of serum progesterone levels measured according to the type of micronized vaginal progesterone used to support the luteal phase, we obtained for day P + 4 (13,69 for Progeffik® vs 15.89 for Cyclogest®), while for day P + 5 (11.95 vs 17.69) and on day P + 19 (13.69 vs 15.41), the results obtained after the administration of Cyclogest® being significantly higher with a p-value of 0,01. When assessing the ongoing pregnancy rate, they were also significantly higher with the administration of Cyclogest® versus Progeffik® (59.7% vs 48.3%) with a p value of 0,024. Limitations, reasons for caution The newborm rate needs to be validated as it has not exceeded 9 months since the study. Wider implications of the findings This study demonstrates the statistically significant superiority of Cyclogest-type vaginal micronized progesterone administration over its competitor Progeffik used for luteal phase support, being a more convenient way of administration for women since it's simplicity. Trial registration number 0388-N-22

O-132 Comparison of pregnancy rates in antagonist cycles after luteal support with GnRH-agonist versus progesterone – prospective randomized study

Abstract Study question Are pregnancy rates in GnRH-antagonist cycles triggered with hCG and luteal phase support (LPS) with intranasal GnRH-agonist or vaginal progesterone comparable? Summary answer Nasal GnRH-agonist for LPS is associated with higher pregnancy rates compared with standard progesterone support in antagonist-based cycles triggered with hCG What is known already Regardless of its mechanism of action, the use of GnRH-a during the luteal phase in addition to progesterone, either in a single or multiple doses, has become a common practice as a part of ART protocols, based on its association with higher pregnancy and live birth rates . Its use as a sole agent for LPS has not gained the same popularity although studies supporting non-inferiority and even higher live birth rates with GnRH-a as a sole LPS agent have been published. Study design, size, duration A single-center, prospective, randomized study. A total of 150 patients underwent 164 GnRH-antagonist-based IVF cycles triggered with hCG and fresh embryo transfer. The study was conducted between June 9th, 2020, and May 5th, 2022. Participants/materials, setting, methods The study was conducted in the IVF clinic at University-affiliated tertiary medical center. Patients meeting the inclusion criteria who underwent antagonist-based IVF cycles and hCG triggering were enrolled. Computer-based randomization (1:1 ratio) was performed on the day of oocyte pickup (OPU). In both groups LPS was initiated on the evening of the OPU day with either GnRH-agonist nasal spray (Nafareline, nasal spray 200 mcg twice daily)or vaginal micronized progesterone (Utrogestan 300 mg, 3 times daily). Main results and the role of chance A total of 150 patients underwent 164 cycles, 127 cycles of which were included in the study cohort. Of them, 64 (50.4%) and 63 (49.6%) cycles were treated with GnRH-agonist or progesterone respectively as sole luteal phase support. A significantly higher pregnancy rate was found in the GnRH-a group compared with the progesterone group (43.8% versus 25.4% respectively; P = 0.030). After adjustment of several potential confounders such as age, body mass index (BMI), past obstetric history, number of IVF cycles, oocytes retrieved and embryos transferred, GnRH-agonist was still associated with a higher pregnancy rate (odds ratio 3.4, 95% confidence interval 1.4-8.3). Ovarian hyperstimulation syndrome (OHSS) rates were similar between the groups. Significantly higher progesterone levels were measured at β-hCG testing day in the GnRH-a group, both for the cleavage stage embryos (129.1±23.7 nmol/L vs. 97.7±48.9 nmol/L, P = 0.024) and for the blastocysts (127.2±0.1 nmol/L vs. 75.3±49.1 nmol/L, P = 0.034). Limitations, reasons for caution This study is not powered for analysis of clinical pregnancy rates, live birth rates and pregnancy outcomes. Larger studies are needed for research of these outcomes. All patients participating were at low risk for OHSS, therefore the study is underpowered to find significant differences in early or late OHSS.Wider implications of the findings Our findings suggest that intranasal GnRH-agonist administration as a sole luteal support in antagonist-based IVF cycles triggered with hCG results in higher pregnancy rates in comparison with traditional irritating vaginal preparations while not mandating additional support in the first weeks of pregnancy. Trial registration number Clinicaltrials.gov - NCT05484193

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

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.