A Study of the Effect of Preoperative Vaginal Antiseptic on Occurrence of Postoperative Infection in Cesarean Section

Abstract

Aim: Cesarean delivery is one of the most common surgical procedures in obstetric practice and its incidence is rising worldwide. In Egypt, the past decade has witnessed a sharp increase in the CS rate to reach about 52 %. Post cesarean section (CS) infectious morbidity is a major health problem, which can lead to maternal health morbidities in addition to economic burden. Endometritis, febrile morbidity and wound infection are considered of the most frequent complications of post cesarean infections. Endometritis is the commonest complication as it accounts up to 27%, followed by clinically significant fever, which was reported as 5-24%, while the incidence of wound infection is about 2-9%. This complication, up to 10 times more frequent after a cesarean delivery than after vaginal delivery. Materials and Methods: This study was conducted on 54 females undergoing elective cesarean section, admitted to El-Shatby Maternity University Hospital. Patients were divided into two groups, each group contained 27 cases. The first group received Preoperative vaginal cleaning with10% povidone iodine for 30 seconds. The second group did not receive preoperative vaginal cleaning. Results: The Comparison between the two studied groups regarding incidence of febrile morbidity, post-operative endometritis and wound infection were statistically significant; P = (0.009), (0.024) and (0.018) respectively. Appling povidone iodine reduced the rate from 37 % in the control group to 7.4 % in the treatment group, post-operative endometritis rate from 29.6 % in the control group to 3.7% in the treatment group and post-operative wound infection rate from 33.3 % in the control group to 7.4 % in the treatment group. Conclusion:This study has shown that vaginal cleaning with povidone iodine prior to cesarean section can prevent postoperative febrile morbidity.

Health Systems Interventions for Prevention of Maternal Peripartum Infection in Low and Middle Income Countries: A Systematic Review

“…The studies covered a wide geographical area with a majority in inpatient settings. Seven studies were conducted in Egypt [15,24,25,26,27,28,29], ve studies in India [12,14,30,31,32], four studies in Nigeria [33,34,35,36], three studies in Tanzania [8, 37,38,39], two studies each in Sudan [40,41], Uganda [13,42] and Bangladesh [30,43]. While one study each in South Africa [44], Gambia [46], Malawi [47] and Iran [48].…”

“…Six studies [13,14,15,28,33, the effect of skin preparation in the prevention of maternal peripartum infection with a total of 8538 women (Table 1). For the administration of the antiseptics, the studies used vaginal preparations via sterile gauzes, sponge sticks and a full bath with soap containing antiseptic.…”

“…Women in the intervention group had lower infections (12%) than those in the control (36.8%). In a similar study in Egypt, [15] involving 54 women split into two groups with one group receiving preoperative vaginal cleansing with povidone-iodine and the other none. The rate of infections was reduced in the treatment group (7.4%) than in the control (37%).…”

“…Implications of the ndings to policy makers and practitioners in health systems and public health outcomes is that preoperative vaginal cleansing with povidine or chlorhexidine is a simple and a cost effective intervention that may be considered before performing CS and should be part of the hospital routine care to reduce the risk of post-CS infection [13,15,28,33,47].…”

“…The risk factors are known and the infection is preventable [4][5][6][7][8][9][10][11]. Several interventions have been documented [12][13][14][15][16][17][18][19][20] however, maximum effectiveness and further reduction of the infection can be achieved if the existing interventions are aligned through a health systems approach [1]. It is from this ground that a health systems evaluation of the available interventions of prevention is necessary however, evidence on health systems interventions is less well documented.…”