Effects of two different perineal preparations before vaginal birth on maternal and neonatal infections and hospital...

Perineal preparation during the second stage of labor may influence maternal and neonatal infection risk and healthcare resource utilization. Although povidone-iodine sterilization is traditionally used, microbial flora theory suggests that water cleansing may preserve normal flora without increasing infection while reducing workload and cost. This study compared water cleansing with povidone-iodine sterilization for perineal preparation at Far East Memorial Hospital, Taiwan, from 26 November 2024 to 5 June 2025.

A randomized controlled trial design was employed, including 143 mothers randomly assigned to either the water cleansing group (n=72) or the povidone-iodine sterilization group (n=71). Outcome measures included maternal and neonatal infection parameters (maternal postpartum temperature, C-reactive protein, REEDA scores, neonatal temperature, and neonatal oral flora colonization), along with cleansing time and medical costs. Data were analyzed using t-tests, chi-squared tests, and generalized estimating equation (GEE).

GEE analysis revealed no significant differences between the two groups in maternal and neonatal infection indicators (REEDA, 95% CI: -0.53-0.18, p=0.337; maternal temperature, 95% CI: -0.06-0.21, p=0.278; neonate temperature, 95% CI: -0.12-0.19, p=0.636). The water group had significantly lower average medical costs than the povidone-iodine group (7.49 vs 110.92 TWD, t= -50.22, p<0.001), as well as a shorter cleansing time. Regarding neonatal flora colonization, the water group showed higher rates of normal flora (33.8% vs 15.5%) and lower rates of pathogenic bacteria (5.6% vs 12.7%, χ²=10.88, p=0.028).

Perineal preparation with water was not associated with an increased risk of maternal or neonatal infection or adverse neonatal oral microbial colonization at birth and was associated with lower medical costs. These findings suggest that water may be a safe and cost-effective alternative to povidone-iodine for perineal preparation among women with low-risk pregnancies in hospitals with high episiotomy rates. Further longitudinal studies are needed to determine the effects of intrapartum povidone-iodine exposure on neonatal microbiome development and its potential long-term health consequences.

The study is registered on the official website of ClinicalTrials.gov.

NCT06880445.