Preoperative Vaginal Cleansing with Povidone Iodine and the Risk of Post Elective Cesarean Endometritis

Abstract

Cesarean section is one of the most frequently performed surgical procedures by obstetricians. Despite the wide spread use of prophylactic antibiotic, post operative infections still a serious complication of cesarean section which includes endometritis, wound infection, urinary tract infection, pelvic abscess and septic pelvic thrombo-phlebitis. Endometritis is a complication that occur after labour and more common after cesarean section than normal vaginal delivery. Endometritis is an infection of endometrium (lining of the uterus) with a characteristic triad (fever 38oC and more, uterine tenderness and offensive vaginal discharge) which need intravenous broad spectrum antibiotics. This infection is polymicrobial that move up from vaginal tract and cervix to infect endometrium. Povidone iodine is an antiseptic solution that is widely used and very effective as skin antiseptic scruber for surgical site preparation. It has microbicidal activity against bacteria, fungi and protozoa. Other uses include treatment and prevention of infection in wounds and ulcers, vaginal wash in vaginitis and can be loaded in to hydrogel for wound dressing. This study is a randomized case control study to examine the efficacy of preoperative vaginal cleansing with 10% povidone iodine before elective caesarean section in reducing risk of post cesarean endometritis, where women were recruited in two groups first group would receive preoperative vaginal cleansing with 10% povidone iodine while other group would not receive cleansing even with tap water. The patients were followed up during the first 24 hours after cesarean section for the presence of triad of endometritis (fever 38oC and more, uterine tenderness and offensive vaginal discharge), also laboratory investigations were done as C-reactive protein and white blood cell count. The incidence of endometritis was found to be 1.3% in study group and 7.2% in control group (p-value 0.020), that means significant result supporting the hypothesis theory, which means that vaginal cleansing with povidone iodine before cesarean section decrease the risk of postoperative endometritis.