Preoperative vaginal cleansing with chlorhexidine solution in preventing post‐cesarean section infections in a low resource setting: A randomized controlled trial
Introduction Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgic...
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| Veröffentlicht in: | Acta obstetricia et gynecologica Scandinavica 2021-04, Vol.100 (4), p.694-703 |
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| creator | Ogah, Christian O. Anikwe, Chidebe C. Ajah, Leonard O. Ikeotuonye, Arinze C. Lawani, Osaheni L. Okorochukwu, Bartholomew C. Ikeoha, Cyril C. Okoroafor, Francis C. |
| description | Introduction
Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post‐cesarean section infectious morbidities.
Material and methods
This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE‐FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine‐alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine‐alcohol. All the women received pre‐ and postoperative antibiotics. The primary outcomes were endometritis and wound infections.
Results
Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16‐0.53; P |
| doi_str_mv | 10.1111/aogs.14060 |
| format | Article |
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Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post‐cesarean section infectious morbidities.
Material and methods
This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE‐FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine‐alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine‐alcohol. All the women received pre‐ and postoperative antibiotics. The primary outcomes were endometritis and wound infections.
Results
Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16‐0.53; P < .05). Foul‐smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30‐64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species.
Conclusions
Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post‐cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.</description><identifier>ISSN: 0001-6349</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.14060</identifier><identifier>PMID: 33351989</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>Administration, Intravaginal ; Anti-Infective Agents, Local - administration & dosage ; Antibiotics ; Cesarean Section ; chlorhexidine ; Chlorhexidine - administration & dosage ; endometritis ; Female ; Humans ; Infections ; Morbidity ; Nigeria ; postoperative ; Pregnancy ; Preoperative Care ; Prospective Studies ; Surgical Wound Infection - prevention & control ; Vagina ; vaginal cleansing</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2021-04, Vol.100 (4), p.694-703</ispartof><rights>2020 Nordic Federation of Societies of Obstetrics and Gynecology</rights><rights>2020 Nordic Federation of Societies of Obstetrics and Gynecology.</rights><rights>Copyright © 2021 Acta Obstetricia et Gynecologica Scandinavica</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3930-cf8d22d52d278f16387e43853c62cb74a3d35a0f14530f59ed10707d29fcc8f3</citedby><cites>FETCH-LOGICAL-c3930-cf8d22d52d278f16387e43853c62cb74a3d35a0f14530f59ed10707d29fcc8f3</cites><orcidid>0000-0002-3730-621X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faogs.14060$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faogs.14060$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33351989$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ogah, Christian O.</creatorcontrib><creatorcontrib>Anikwe, Chidebe C.</creatorcontrib><creatorcontrib>Ajah, Leonard O.</creatorcontrib><creatorcontrib>Ikeotuonye, Arinze C.</creatorcontrib><creatorcontrib>Lawani, Osaheni L.</creatorcontrib><creatorcontrib>Okorochukwu, Bartholomew C.</creatorcontrib><creatorcontrib>Ikeoha, Cyril C.</creatorcontrib><creatorcontrib>Okoroafor, Francis C.</creatorcontrib><title>Preoperative vaginal cleansing with chlorhexidine solution in preventing post‐cesarean section infections in a low resource setting: A randomized controlled trial</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Introduction
Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post‐cesarean section infectious morbidities.
Material and methods
This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE‐FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine‐alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine‐alcohol. All the women received pre‐ and postoperative antibiotics. The primary outcomes were endometritis and wound infections.
Results
Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16‐0.53; P < .05). Foul‐smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30‐64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species.
Conclusions
Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post‐cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.</description><subject>Administration, Intravaginal</subject><subject>Anti-Infective Agents, Local - administration & dosage</subject><subject>Antibiotics</subject><subject>Cesarean Section</subject><subject>chlorhexidine</subject><subject>Chlorhexidine - administration & dosage</subject><subject>endometritis</subject><subject>Female</subject><subject>Humans</subject><subject>Infections</subject><subject>Morbidity</subject><subject>Nigeria</subject><subject>postoperative</subject><subject>Pregnancy</subject><subject>Preoperative Care</subject><subject>Prospective Studies</subject><subject>Surgical Wound Infection - prevention & control</subject><subject>Vagina</subject><subject>vaginal cleansing</subject><issn>0001-6349</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuKFDEUhoMoTju68QEk4EaEGnOrm7tm0FEYGMHZF5nkpDtDOimTVPeMKx_Bh_DJfBJTVuvChdnkBL7_g5MfoeeUnNFy3siwSWdUkIY8QCvaEFIRQdlDtCKE0Krhoj9BT1K6LS_Wiu4xOuGc17Tv-hX68SlCGCHKbPeA93JjvXRYOZA-Wb_BB5u3WG1diFu4s9p6wCm4KdvgsfV4jLAHn2dyDCn__PZdQZKxpHECdaTMMqU5ILELBxwhhSmq4oI8h9_iNY7S67CzX0FjFXyOwbky5mile4oeGekSPDvep-j6_bvr8w_V5dXFx_P1ZaV4z0mlTKcZ0zXTrO0MbXjXguBdzVXD1E0rJNe8lsRQUXNi6h40JS1pNeuNUp3hp-jVoh1j-DJBysPOJgXOSQ9hSgMTLRdE1Kwp6Mt_0NuyUPm6QtWUsZY1jBfq9UKpGFKKYIYx2p2M9wMlw1zdMFc3_K6uwC-OyulmB_ov-qerAtAFOFgH9_9RDeuri8-L9BcD1Khh</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Ogah, Christian O.</creator><creator>Anikwe, Chidebe C.</creator><creator>Ajah, Leonard O.</creator><creator>Ikeotuonye, Arinze C.</creator><creator>Lawani, Osaheni L.</creator><creator>Okorochukwu, Bartholomew C.</creator><creator>Ikeoha, Cyril C.</creator><creator>Okoroafor, Francis C.</creator><general>John Wiley & Sons, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3730-621X</orcidid></search><sort><creationdate>202104</creationdate><title>Preoperative vaginal cleansing with chlorhexidine solution in preventing post‐cesarean section infections in a low resource setting: A randomized controlled trial</title><author>Ogah, Christian O. ; Anikwe, Chidebe C. ; Ajah, Leonard O. ; Ikeotuonye, Arinze C. ; Lawani, Osaheni L. ; Okorochukwu, Bartholomew C. ; Ikeoha, Cyril C. ; Okoroafor, Francis C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3930-cf8d22d52d278f16387e43853c62cb74a3d35a0f14530f59ed10707d29fcc8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Administration, Intravaginal</topic><topic>Anti-Infective Agents, Local - administration & dosage</topic><topic>Antibiotics</topic><topic>Cesarean Section</topic><topic>chlorhexidine</topic><topic>Chlorhexidine - administration & dosage</topic><topic>endometritis</topic><topic>Female</topic><topic>Humans</topic><topic>Infections</topic><topic>Morbidity</topic><topic>Nigeria</topic><topic>postoperative</topic><topic>Pregnancy</topic><topic>Preoperative Care</topic><topic>Prospective Studies</topic><topic>Surgical Wound Infection - prevention & control</topic><topic>Vagina</topic><topic>vaginal cleansing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ogah, Christian O.</creatorcontrib><creatorcontrib>Anikwe, Chidebe C.</creatorcontrib><creatorcontrib>Ajah, Leonard O.</creatorcontrib><creatorcontrib>Ikeotuonye, Arinze C.</creatorcontrib><creatorcontrib>Lawani, Osaheni L.</creatorcontrib><creatorcontrib>Okorochukwu, Bartholomew C.</creatorcontrib><creatorcontrib>Ikeoha, Cyril C.</creatorcontrib><creatorcontrib>Okoroafor, Francis C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ogah, Christian O.</au><au>Anikwe, Chidebe C.</au><au>Ajah, Leonard O.</au><au>Ikeotuonye, Arinze C.</au><au>Lawani, Osaheni L.</au><au>Okorochukwu, Bartholomew C.</au><au>Ikeoha, Cyril C.</au><au>Okoroafor, Francis C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative vaginal cleansing with chlorhexidine solution in preventing post‐cesarean section infections in a low resource setting: A randomized controlled trial</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2021-04</date><risdate>2021</risdate><volume>100</volume><issue>4</issue><spage>694</spage><epage>703</epage><pages>694-703</pages><issn>0001-6349</issn><eissn>1600-0412</eissn><abstract>Introduction
Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post‐cesarean section infectious morbidities.
Material and methods
This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE‐FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine‐alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine‐alcohol. All the women received pre‐ and postoperative antibiotics. The primary outcomes were endometritis and wound infections.
Results
Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16‐0.53; P < .05). Foul‐smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30‐64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species.
Conclusions
Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post‐cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.</abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>33351989</pmid><doi>10.1111/aogs.14060</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3730-621X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Administration, Intravaginal Anti-Infective Agents, Local - administration & dosage Antibiotics Cesarean Section chlorhexidine Chlorhexidine - administration & dosage endometritis Female Humans Infections Morbidity Nigeria postoperative Pregnancy Preoperative Care Prospective Studies Surgical Wound Infection - prevention & control Vagina vaginal cleansing |
| title | Preoperative vaginal cleansing with chlorhexidine solution in preventing post‐cesarean section infections in a low resource setting: A randomized controlled trial |
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