Postoperative Vaginal Cleansing with Chlorhexidine Gluconate Versus Povidone-Iodine for Prevention of Post-Caesarean Endometritis: A Randomized Controlled Trial

Maternal infectious morbidity is a common complication of caesarean section. Despite prophylactic antibiotics, endometritis following caesarean section is still a big challenge. Preoperative vaginal cleansing with povidone may not be feasible in emergencies necessitating its use postoperatively, and comparing its efficacy with cheaper and readily available solutions. The aim is to compare the effectiveness of post-operative vaginal cleansing with povidone-iodine(PI) versus chlorhexidine gluconate (CHG) in reducing post-caesarean endometritis.

This was a single-blinded randomized controlled trial. One hundred and twenty participants had post-operative vaginal cleansing with Povidone-iodine and one hundred and nineteen with Chlorhexidine gluconate, with attrition of 2 and 3 participants from the PI and CHG groups, respectively. Both groups received prophylactic antibiotics. They were reviewed for endometritis daily till discharge or up to 7 days. Data was analysed with SPSS.

The study showed that post-caesarean vaginal cleansing with either agent did not detect any case of endometritis. Although the duration of ruptured membranes prior to surgery was statistically significant, with a mean of 19.26±44.4, 8.7±10.9 for PI and CHG, respectively, p-0.038; RR-0.627-21.561. Post-operative fever was recorded in the PI group (0.02%) but was not statistically significant. p=2.773; RR=1.667; 95%CI (0.624-3.957). No adverse effect was reported with either agent, Anaphlactic reaction=0, and local irritation was 1.67% with P=0.498.

Post-operative vaginal cleansing with CHG was not superior to PI in preventing the occurrence of post-Caesarean endometritis. Although CHG had a better side effect profile when compared with PI, the findings were not statistically significant. CHG may be recommended for use following result from multicentre studies.