Department of Experimental Clinical and Medical Science, DISM, Clinic of Obstetrics and Gynecology, University of Udine, Udine, and the Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; and the Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy.
Obstet Gynecol. 2017 Sep;130(3):527-538. doi: 10.1097/AOG.0000000000002167.
To assess the efficacy of vaginal cleansing before cesarean delivery in reducing postoperative endometritis.
MEDLINE, Ovid, EMBASE, Scopus, Clinicaltrials.gov, and Cochrane Library were searched from their inception to January 2017.
Selection criteria included all randomized controlled trials comparing vaginal cleansing (ie, intervention group) with a control group (ie, either placebo or no intervention) in women undergoing cesarean delivery. Any method of vaginal cleansing with any type of antiseptic solution was included. The primary outcome was the incidence of endometritis. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% CI.
TABULATION, INTEGRATION, AND RESULTS: Sixteen trials (4,837 women) on vaginal cleansing immediately before cesarean delivery were identified as relevant and included in the review. In most of the included studies, 10% povidone-iodine was used as an intervention. The most common way to perform the vaginal cleansing was the use of a sponge stick for approximately 30 seconds. Women who received vaginal cleansing before cesarean delivery had a significantly lower incidence of endometritis (4.5% compared with 8.8%; RR 0.52, 95% CI 0.37-0.72; 15 studies, 4,726 participants) and of postoperative fever (9.4% compared with 14.9%; RR 0.65, 95% CI 0.50-0.86; 11 studies, 4,098 participants) compared with the control group. In the planned subgroup analyses, the reduction in the incidence of endometritis with vaginal cleansing was limited to women in labor before cesarean delivery (8.1% compared with 13.8%; RR 0.52, 95% CI 0.28-0.97; four studies, 440 participants) or those with ruptured membranes (4.3% compared with 20.1%; RR 0.23, 95% CI 0.10-0.52; three studies, 272 participants).
Vaginal cleansing immediately before cesarean delivery in women in labor and in women with ruptured membranes reduces the risk of postoperative endometritis. Because it is generally inexpensive and a simple intervention, we recommend preoperative vaginal preparation before cesarean delivery in these women with sponge stick preparation of povidone-iodine 10% for at least 30 seconds. More data are needed to assess whether this intervention may be also useful for cesarean deliveries performed in women not in labor and for those without ruptured membranes.
PROSPERO International prospective register of systematic reviews, https://www.crd.york.ac.uk/PROSPERO/, CRD42017054843.
评估剖宫产术前阴道冲洗在降低术后子宫内膜炎方面的疗效。
检索 MEDLINE、Ovid、EMBASE、Scopus、Clinicaltrials.gov 和 Cochrane Library，检索时间截至 2017 年 1 月。
选择标准包括所有比较剖宫产术前阴道冲洗（即干预组）与对照组（即安慰剂或无干预）的随机对照试验。纳入任何方法使用任何类型的抗菌溶液进行的阴道冲洗。主要结局为子宫内膜炎的发生率。采用 DerSimonian 和 Laird 的随机效应模型进行荟萃分析，以产生相对风险（RR）和 95%置信区间（CI）的汇总治疗效果。
列表、整合和结果：共确定了 16 项关于剖宫产术前即刻阴道冲洗的试验（4837 名女性），并将其纳入综述。在大多数纳入的研究中，10%的聚维酮碘被用作干预措施。最常见的阴道冲洗方法是使用海绵棒大约 30 秒。与对照组相比，接受剖宫产术前阴道冲洗的女性子宫内膜炎的发生率显著降低（4.5%比 8.8%；RR 0.52，95%CI 0.37-0.72；15 项研究，4726 名参与者）和术后发热（9.4%比 14.9%；RR 0.65，95%CI 0.50-0.86；11 项研究，4098 名参与者）。在计划的亚组分析中，阴道冲洗对子宫内膜炎发生率的降低仅限于剖宫产术前分娩的女性（8.1%比 13.8%；RR 0.52，95%CI 0.28-0.97；4 项研究，440 名参与者）或胎膜破裂的女性（4.3%比 20.1%；RR 0.23，95%CI 0.10-0.52；3 项研究，272 名参与者）。
在分娩和胎膜破裂的女性中，剖宫产术前即刻阴道冲洗可降低术后子宫内膜炎的风险。由于它通常价格低廉且是一种简单的干预措施，因此我们建议对这些女性进行术前阴道准备，使用 10%的聚维酮碘海绵棒准备至少 30 秒。需要更多的数据来评估该干预措施是否对非分娩和无胎膜破裂的剖宫产也有用。
PROSPERO 国际前瞻性系统评价注册，https://www.crd.york.ac.uk/PROSPERO/，CRD42017054843。
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