Preoperative Vaginal Preparation with Povidone-Iodine and Post-Cesarean Infectious Morbidity

Objective: To determine whether vaginal preparation with povidone-iodine before cesarean section decrease the incidence of postpartum infectious morbidity. Methods: A randomized, controlled study was performed on 304 women undergoing non-emergency cesarean delivery. The subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotics at the time of umbilical cord clamping. Each subject s postoperative course was reviewed for development of febrile morbidity (temperature 38.0°C), endometritis (temperature 38.4°C accompanied by fundal tenderness occurring beyond the first postoperative day, in absence of evidence of other infection), and wound infection. Results: Post-cesarean endometritis occurs in 4.7% of subjects who received a preoperative vaginal preparation and 14.1% of controls (p=0.0097). There was no measurable effect of a vaginal scrub on development of postoperative fever or wound infection. The adjusted odd ratio (OR) for developing endometritis after a vaginal preparation was 0.33 (95% confidence interval [CI] 0.287-0.831). Multivariate analysis showed an increased risk of developing endometritis in association with severe anaemia (adjusted OR 1.22, 95% CI 0.755- 1.975). Use of intrapartum internal monitors (adjusted OR 1.03, 95% CI 0.601-1.756), or history of antenatal genitourinary infection (adjusted OR 0.988, 95% CI 0.612-1.596). Conclusion: Preoperative vaginal scrub with povidoneiodine decreases incidence of post-cesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection.