Povidone-iodine best for vaginal prep prior to CD

  • Roeckner JT & al.
  • Am J Obstet Gynecol
  • 4 Apr 2019

  • International Clinical Digest
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Takeaway

  • Vaginal povidone-iodine prior to cesarean delivery (CD) is the best choice for prophylaxis against postpartum endometritis, fever, and wound infections.

Why this matters

  • These data support the use of 1% povidone-iodine application in women undergoing planned CD, as well as CD after membranes rupture and/or labor.
  • CD is a common surgery, and reducing risks for complications will improve maternal health.

Key results

  • 1% povidone-iodine reduced the rate of endometritis (OR, 0.43; 95% CI, 0.28-0.64) compared with no treatment.
  • Chlorhexidine reduced risk for endometritis, but results not statistically significant (OR, 0.71; 95% CI, 0.38-1.33).
  • Povidone-iodine reduced risks for postpartum fever and wound infection (OR, 0.61; 95% CI, 0.48-0.78).

Study design

  • Systematic review and meta-analysis.
  • 23 studies using various vaginal antiseptic preparations prior to CD were included.
  • Primary outcome was endometritis (temperature >38°C, uterine tenderness, and/or foul smelling vaginal discharge).
  • Secondary outcomes included postoperative fever and wound infection.
  • Funding: Department of Obstetrics and Gynecology, University of Florida College of Medicine Jacksonville.

Limitations

  • Limitations related to limitations of original studies.
  • Potential confounding factors and selection bias possible.

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