Preoperative vaginal preparation with povidone- iodine and the risk of postcesarean endometritis

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 105; no. 5; pp. 1024 - 1029
• Main Authors: STARR, Rosally V, ZURAWSKI, Jill, ISMAIL, Mahmoud
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01.05.2005
• Subjects: Adult; Anti-Infective Agents, Local - adverse effects; Anti-Infective Agents, Local - therapeutic use; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Cesarean Section - adverse effects; Cesarean Section - methods; Elective Surgical Procedures; Endometritis - chemically induced; Endometritis - epidemiology; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Human bacterial diseases; Humans; Incidence; Infectious diseases; Logistic Models; Medical sciences; Multivariate Analysis; Povidone-Iodine - adverse effects; Povidone-Iodine - therapeutic use; Pregnancy; Preoperative Care - methods; Reference Values; Risk Assessment; Surgical Wound Infection - chemically induced; Surgical Wound Infection - epidemiology; Povidone; Gynecology; Preparation; Risk factor; Uterine diseases; Vagina; Preoperative; Endometritis; Obstetrics; Female genital diseases; Iodine
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/01.AOG.0000164032.16599.7e

Postcesarean endometritis and wound infection remain significant morbidities, despite use of strategies to prevent these complications. We investigated the effect of preoperative vaginal preparation with povidone-iodine as a preventive intervention against postcesarean endometritis and wound infection. A randomized controlled study was performed in 308 women undergoing nonemergent cesarean delivery. Subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotic at the time of umbilical cord clamping. Each subject's postoperative course was reviewed for development of febrile morbidity (temperature > 38.0 degrees C), endometritis (temperature > 38.4 degrees C accompanied by fundal tenderness occurring beyond the first postoperative day, in the absence of evidence of other infection), and wound infection. Postcesarean endometritis occurred in 7.0% of subjects who received a preoperative vaginal preparation and 14.5% of controls (P < .05). There was no measurable effect of a vaginal scrub on the development of postoperative fever or wound infection. The adjusted odds ratio for developing endometritis after a vaginal preparation was 0.44 (95% confidence interval [CI] 0.193-0.997). Multivariate analysis showed an increased risk of developing endometritis in association with severe anemia (adjusted OR 4.26, 95% CI 1.568-11.582), use of intrapartum internal monitors (adjusted OR 2.84, 95% CI 1.311-6.136), or history of antenatal genitourinary infection (adjusted OR 2.9, 95% CI 1.265-6.596). Preoperative vaginal scrub with povidone-iodine decreases the incidence of postcesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection.