Hadiati Diah R, Hakimi Mohammad, Nurdiati Detty S
Department of Obstetrics and Gynaecology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
Cochrane Database Syst Rev. 2012 Sep 12(9):CD007462. doi: 10.1002/14651858.CD007462.pub2.
The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section than for vaginal birth. With the increase in caesarean section, it is important that the risks to the mother are minimised as far as possible. This review focuses on different forms and methods for preoperative skin preparation to prevent infection.
To compare the effects of different agent forms and methods of preoperative skin preparation for preventing postcaesarean infection.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 January 2012) and the reference lists of all included studies and review articles
Randomised and quasi-randomised trials, including cluster-randomised trials, evaluating any type of preoperative skin preparation agents, forms and methods of application for caesarean section.
Three review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using a predesigned form. Data were checked for accuracy.
We included five trials with a total of 1462 women. No difference was found in the primary outcomes of either wound infection or endometritis. Two trials of 1294 women, compared drape with no drape (one trial using iodine and the other using chlorhexidine) and found no significant difference in wound infection (risk ratio (RR) 1.29; 95% confidence interval (CI) 0.97 to 1.71). One trial of 79 women comparing alcohol scrub and iodophor drape with iodophor scrub without drape reported no wound infection in either group. One trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in wound infection (RR 0.33; 95% CI 0.04 to 2.99).Two trials reported endometritis, one trial comparing alcohol scrub and iodophor drape with iodophor scrub only found no significant difference (RR 1.62; 95% CI 0.29 to 9.16). The other trial of 50 women comparing parachlorometaxylenol plus iodine with iodine alone reported no significant difference in endometritis (RR 0.88; 95% CI 0.56 to 1.38). No difference was found in the secondary outcome of either length of stay or reduction of skin bacteria colony count. No trial reported other maternal outcomes, i.e. maternal mortality, repeat surgery and re-admission resulting from infection. One trial, which was only available as an abstract, investigated the effect of skin preparation on neonatal adverse events and found cord blood iodine concentration to be significantly higher in the iodine group.
AUTHORS' CONCLUSIONS: Little evidence is available from the included randomised controlled trials to evaluate different agent forms, concentrations and methods of skin preparation for preventing infection following caesarean section. Therefore, it is not yet clear what sort of skin preparation may be most efficient for preventing postcaesarean wound and surgical site infection. There is a need for high-quality, properly designed randomised controlled trials with larger sample sizes in this field. High priority questions include comparing types of antiseptic (especially iodine versus chlorhexidine), the timing and duration of applying the antiseptic (especially previous night versus day of surgery, and application methods (scrubbing, swabbing and draping).
剖宫产的孕产妇死亡和发病风险（尤其是术后感染）高于阴道分娩。随着剖宫产率的上升，尽可能降低对母亲的风险至关重要。本综述聚焦于术前皮肤准备预防感染的不同形式和方法。
比较不同剂型和术前皮肤准备方法预防剖宫产术后感染的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2012年1月2日）以及所有纳入研究和综述文章的参考文献列表。
随机和半随机试验，包括整群随机试验，评估剖宫产术前任何类型的皮肤准备剂、剂型和应用方法。
三位综述作者独立评估所有可能纳入的研究，评估偏倚风险并使用预先设计的表格提取数据。检查数据准确性。
我们纳入了5项试验，共1462名女性。在伤口感染或子宫内膜炎的主要结局方面未发现差异。两项涉及1294名女性的试验，比较了使用手术单与不使用手术单（一项试验使用碘，另一项使用氯己定），发现伤口感染无显著差异（风险比（RR）1.29；95%置信区间（CI）0.97至1.71）。一项涉及79名女性的试验比较了酒精擦浴加碘伏手术单与无手术单的碘伏擦浴，两组均未报告伤口感染。一项涉及50名女性的试验比较了对氯间二甲苯酚加碘与单纯碘，伤口感染无显著差异（RR 0.33；95%CI 0.04至2.99）。两项试验报告了子宫内膜炎，一项试验比较了酒精擦浴加碘伏手术单与仅碘伏擦浴，未发现显著差异（RR 1.62；95%CI 0.29至9.16）。另一项涉及50名女性的试验比较了对氯间二甲苯酚加碘与单纯碘，子宫内膜炎无显著差异（RR 0.88；95%CI 0.56至1.38）。在住院时间或皮肤细菌菌落计数减少的次要结局方面未发现差异。没有试验报告其他孕产妇结局，即孕产妇死亡、再次手术和因感染再次入院。一项仅以摘要形式提供的试验研究了皮肤准备对新生儿不良事件的影响，发现碘组脐带血碘浓度显著更高。
纳入的随机对照试验几乎没有证据可用于评估不同剂型、浓度和皮肤准备方法预防剖宫产术后感染的效果。因此，尚不清楚哪种皮肤准备可能对预防剖宫产伤口和手术部位感染最有效。该领域需要高质量、设计合理且样本量更大的随机对照试验。高度优先的问题包括比较防腐剂类型（尤其是碘与氯己定）、防腐剂应用的时间和持续时间（尤其是前一晚与手术当天，以及应用方法（擦浴、擦拭和使用手术单）。
