In five studies, the advantage of repeated vaginal prophylaxis by a new preparation of hexetidine vaginal suppositories (10 mg) was investigated prospectively, randomised and method-controlled (n = 2 x 50). After a five-day application, the hexetidine group achieved bacterial reductions of five log CFU/ml in the vagina and nearly three log CFU/ml in the cervix uteri, whilst no reduction was found in the controls at any time (p less than 0.01). The reduction of individual bacterial species was investigated in 224 pregnant and also gynaecological patients. In cases of impending preterm childbirth, a five-day application of 20 mg hexetidine/day could reduce all bacteria sufficiently with the exception of lactobacilli; especially beta Streptococci were reduced. The same was achieved by a three-day application of 10 mg hexetidine/day pre-operatively. A long-term study in 11,724 deliveries showed, that neonatal infectious mortality and morbidity after 36 gestational weeks could be reduced significantly by hexetidine. The new hexetidine preparation appeared to be efficient in vaginal antisepsis, especially in pregnancy. A favourable lactobacilli-selective effect was demonstrated. Since the importance of lactobacilli in vaginal ecology is known, hexetidine prophylaxis must be considered as advantageous in Obstetrics and Gynecology. From a practical and economic point of view, the application of hexetidine as vaginal suppositories appears favourable compared to antiseptic solutions.

In four cases of early rupture of the amnial membranes between the 19, and 29, gestational week, the membranes were closed by fibrin sealing. The pregnancies were prolonged from 5 to maximal 15 weeks. The fetale weights grew from 600 to maximal 2800 g. The children were born vital without infection and a weight between 1300 and 3620 g. The fibrin sealing appears to be a useful method in the obstetrical management.

In 70 gynaecological patients vaginal disinfection by povidone-iodine and chlorhexidine solution (LEC) was investigated. The preoperative bacterial spectrum corresponded to the specifications in literature. Only lactobacilli were found in fewer cases than expected, an effect, which was explained by the povidone-iodine sanitation of the vagina a day before the operation. In cases of disturbed lactobacilli flora, facultative pathogen species were found in high concentrations up to 10(6) CFU/ml. Germ reduction achieved more than 3.4 log CFU/ml in the three groups of antiseptics. Povidone-iodine left a residue of other bacteria species in one-fifth of the cases, one of the LEC-solutions only in one-tenth of the cases. B-Streptococcus, Streptococcus viridans (mitis) and Candida glabrata were found in concentrations up to 10(3) CFU/ml in the residues. In these cases, a disturbed ecology of the vagina had already existed previously. It is concluded, not to disturb normal vaginal flora needlessly before preoperative disinfection and to restore it as soon as possible after operation. The LEC solutions appeared to be a competent alternative to povidone-iodine solution in vaginal disinfection.

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