VAGINA PREPARATION WITH ANTISEPTIC SOLUTION BEFORE CAESAREAN SECTION AND IT EFFECT OF PREVENTING POST-OPERATIVE INFECTIONS: A RANDOMIZED CONTROL TRIAL
Caesarean delivery is one of the most common surgical procedures performed by Obstetricians. Post-operative infections following Caesarean delivery could cause maternal morbidity and mortality. Despite the widespread use of prophylactic antibiotics, post- operative infectious morbidity still complicates caesarean deliveries.
To determine if cleansing the vagina with an antiseptic solution before a caesarean delivery decreases the risk of maternal infectious morbidities including endometritis and wound infection.
Materials and methods
This was a randomized control trial of pregnant women who had emergency caesarean section at University of Abuja Teaching Hospital, Gwagwalada. They were recruited by simple random sampling. All consecutive pregnant women at ≥ 28 weeks gestational age with anindication for emergency caesarean section were counselled for the study. Theparticipants,who met the criteria and consented, were allocated to a study group by a non-blinded simple probability technique with allotment concealment. A total of 266 consecutiveparticipants were recruited, each randomly picked a card in an envelope that assigned her to either control or povidone iodine group. There were 133 participants in the control group and another 133 in the povidone iodine group.At recruitment, bio-social data, gestational age, parity and indication for caesarean section were obtained. Vital signs including temperature and pulse rate were noted. After instituting spinal or general anaesthesia and before cleaning the patient, the participants in the povidone iodine group had their vagina cleansedby rotating once up to 360° with a swab on sponge holding forceps soaked with 10% povidone iodine solution. Such intervention was not done in the control group. The urethral catheter was passed after the vaginal cleansing if not passed earlier in the ward. The time interval between vaginal cleansing and skin incision was within 30 minutes. Routine antibiotics in the form of intravenous ceftriaxone 1000mg and metronidazole 500mg was administered immediately after skin incision. Duration of surgery was recorded. Post-
operatively, endometritis, wound infection andpovidone side effectswere looked for. SPSS version 20 was employed.Categorical data were analysed using Chi-square and Fisher exact test adjusted to odds ratio; mean values were analysed using t-test. The significance of an association was determined at P<0.05 and at 95% confidence interval.
A total of 260 participants (131 in the control group and 129 in the povidone iodine group) were eventually analysed as 2 from control group and 4 from povidone iodine group were lost to follow up.Out of 131 participants in the control group 18(13.7%) had endometritis compared to 4(3.1%) out of the 129 participants in the povidone iodine group. Risk reduction for endometritis with povidone iodine was 8%; and 9 participants need to be treated to prevent one case of endometritis. Incidence of endometritis was significantly higher among participants with ruptured membranes in the control group 14(77.8%), OR (CI) = 0.1(0.01-1.2), p = 0.040. Also endometritis was significantly more among participants with prolonged labourof ≥24hrs duration in the control group 10(55.6%), OR (CI) = 1.3(0.1-10.9), p = 0.041. Other demographic, obstetrics and surgical factors did not show any significant difference between the two groups.Wound infection was more in the control group (11/131 or 8.4%)than in the povidone iodine group (4/129 or 3.1%). Risk reduction of wound infection after using povidone iodine was 6.2%; and 20 participants needto be treated to prevent one case of wound infection. Wound infection was significant among participants with ruptured membranes in the control group 10(90.9%); OR(CI)=0.3(0.01-0.7), p=0.033. Other demographic, obstetrics and surgical factors did not show any significant difference between the two groups.
No adverse effect was noticed from the use of povidone iodine.
Antiseptic vaginal preparation with 10% povidone iodine solution prior to emergency caesarean section, prevents post-caesarean endometritis and wound infection.
The procedure is safe, cheap, simple and easy to perform.