Haas David M, Morgan Sarah, Contreras Karenrose
Department of Obstetrics and Gynecology, Indiana University School of Medicine, 1001 West 10th Street, F-5, Indianapolis, Indiana, 46202, USA.
Cochrane Database Syst Rev. 2014 Dec 21(12):CD007892. doi: 10.1002/14651858.CD007892.pub5.
Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries.
To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 December 2014).
We included randomized and quasi-randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity.
We independently assessed eligibility and quality of the studies.
Seven trials randomizing 2816 women (2635 analyzed) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 8.3% in control groups to 4.3% in vaginal cleansing groups (average risk ratio (RR) 0.45, 95% confidence interval (CI) 0.25 to 0.81, seven trials, 2635 women). The risk reduction was particularly strong for women who were already in labor at the time of the cesarean delivery (7.4% in the vaginal cleansing group versus 13.0% in the control group; RR 0.56, 95% CI 0.34 to 0.95, three trials, 523 women) and for women with ruptured membranes (4.3% in the vaginal cleansing group versus 17.9% in the control group; RR 0.24, 95% CI 0.10 to 0.55, three trials, 272 women). No other outcomes realized statistically significant differences between the vaginal cleansing and control groups. No adverse effects were reported with the povidone-iodine vaginal cleansing.The quality of the evidence using GRADE was low for post-cesarean endometritis, moderate for postoperative fever, and low for wound infection.
AUTHORS' CONCLUSIONS: Vaginal preparation with povidone-iodine solution immediately before cesarean delivery reduces the risk of postoperative endometritis. This benefit is particularly realized for women undergoing cesarean delivery, who are already in labor or who have ruptured membranes. As a simple, generally inexpensive intervention, providers should consider implementing preoperative vaginal cleansing with povidone-iodine before performing cesarean deliveries.
剖宫产是产科医生实施的最常见外科手术之一。剖宫产后的感染性发病情况会对产后女性恢复正常功能以及照顾婴儿的能力产生巨大影响。尽管预防性抗生素已广泛使用，但术后感染性发病情况仍会使剖宫产复杂化。
确定剖宫产术前用消毒溶液清洁阴道是否可降低产妇感染性发病风险，包括子宫内膜炎和伤口并发症。
我们检索了Cochrane妊娠与分娩组试验注册库（2014年12月10日）。
我们纳入了随机和半随机试验，这些试验评估了剖宫产术前立即用任何类型的消毒溶液与安慰剂溶液/标准护理相比，阴道清洁对剖宫产后感染性发病情况的影响。
我们独立评估了研究的合格性和质量。
7项试验将2816名女性随机分组（分析了2635名），评估了阴道清洁（均使用聚维酮碘）对剖宫产后感染性发病情况的影响。偏倚风险总体较低，大多数研究质量较高。剖宫产术前立即进行阴道准备可将剖宫产后子宫内膜炎的发生率从对照组的8.3%显著降低至阴道清洁组的4.3%（平均风险比（RR）0.45，95%置信区间（CI）0.25至0.81，7项试验，2635名女性）。对于剖宫产时已临产的女性（阴道清洁组为7.4%，对照组为13.0%；RR 0.56，95%CI 0.34至0.95，3项试验，523名女性）以及胎膜破裂的女性（阴道清洁组为4.3%，对照组为17.9%；RR 0.24，95%CI 0.10至0.55，3项试验，272名女性），风险降低尤为明显。阴道清洁组和对照组之间的其他结局未实现统计学显著差异。未报告聚维酮碘阴道清洁有不良反应。使用GRADE评估的证据质量，对于剖宫产后子宫内膜炎为低质量，对于术后发热为中等质量，对于伤口感染为低质量。
剖宫产术前立即用聚维酮碘溶液进行阴道准备可降低术后子宫内膜炎的风险。对于已临产或胎膜破裂的剖宫产女性，这一益处尤为明显。作为一种简单且通常成本低廉的干预措施，医疗服务提供者在进行剖宫产术前应考虑采用聚维酮碘进行术前阴道清洁。
