Vaginal Cleansing and Post-Cesarean Infectious Morbidity? Updated Systematic Review and Meta-Analysis of Randomized...

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Surgical Site Infection Control

Background:

• Post-cesarean complications such as endometritis, maternal fever, and wound infection are frequent.
• Evaluating interventions to reduce these common postpartum complications is crucial for maternal health.

Purpose of the Study:

• To assess the incidence of post-cesarean infections following vaginal cleansing before cesarean delivery.
• To compare the effectiveness of different vaginal antiseptic solutions in preventing postpartum infections.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Databases searched included MEDLINE, Scopus, EMBASE, CENTRAL, Google Scholar, Clinicaltrials.gov, and the Register of Controlled Trials.
• Studies involving vaginal antiseptic solutions to reduce postpartum endometritis were included, with PICO: Population (pregnant women), Intervention (vaginal antiseptic), Control (routine care), Outcome (post-cesarean endometritis, wound infection, postoperative fever), Study Design (RCTs).

Main Results:

• 32 RCTs with 13,853 participants were analyzed.
• Vaginal cleansing demonstrated a low incidence of endometritis.
• Chlorhexidine showed an Odds Ratio (OR) of 0.56 for endometritis, while povidone yielded an OR of 0.47.
• Povidone significantly reduced maternal fever (OR = 0.47) and wound infection (OR = 0.59).

Conclusions:

• Vaginal cleansing prior to cesarean section is effective in reducing postoperative complications.
• Povidone solutions, in particular, demonstrate significant efficacy in lowering the incidence of endometritis and maternal fever.
• These findings support the implementation of antiseptic vaginal cleansing protocols to improve maternal outcomes after cesarean delivery.