Adeyemo M, Oyeneyin L, Irinyenikan T, Gbala M, Akadiri O, Bakare B, Adewole S, Ajayi M, Ayodeji O, Akintan A, Adegoke A, Folarin B, Omotayo R, Arowojolu A
Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital Complex, Ondo State, Nigeria.
Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria.
West Afr J Med. 2022 Apr 29;39(4):369-374.
Globally, peripartum or puerperal infections account for about one tenth of maternal mortality, most of which occur in low income countries. Therefore, vaginal preparation with an antiseptic prior to a caesarean delivery could be considered an additional measure to prevent subsequent infectious morbidities.
To evaluate vaginal preparation with 0.3% chlorhexidine solution in the prevention of endometritis, surgical site infection and post-operative fever following emergency caesarean section.
This prospective randomized controlled trial (RCT) was conducted among 240 participants planned for emergency caesarean sections (CS) at term in the University of Medical Sciences Teaching Hospital Complex, Ondo State, Nigeria. Participants were randomised into either group "A" (study) or "B" (control). The former had vaginal preparation with 0.3% chlorhexidine gluconate immediately after anaesthesia while the latter received normal saline. Participants were followed up post-operatively during which clinical features of puerperal infectious morbidities were observed for each during admission as well as 8th and 14th days after delivery.
The rate and risk of endometritis were significantly lower in the study group compared to the control; 5.0% versus 13.3%, respectively (chi squared =5.004; p=0.042, RR = 0.38; 95% CI = 0.15-0.94; p = 0.042; RRR = 0.62). Post-operative fever and surgical site infection, were also lower in the study group compared to the controls, but the difference was not statistically significant.
When compared to placebo, pre-caesarean section vaginal preparation with 0.3% chlorhexidine solution significantly reduced only the rate and risk of post-operative endometritis among infectious morbidities.
在全球范围内，围产期或产褥期感染约占孕产妇死亡的十分之一，其中大部分发生在低收入国家。因此，剖宫产术前用消毒剂进行阴道准备可被视为预防后续感染性疾病的一项额外措施。
评估用0.3%氯己定溶液进行阴道准备对预防急诊剖宫产后子宫内膜炎、手术部位感染和术后发热的效果。
这项前瞻性随机对照试验（RCT）在尼日利亚翁多州大学医学科学教学医院综合体对240名计划进行足月急诊剖宫产（CS）的参与者进行。参与者被随机分为“A”组（研究组）或“B”组（对照组）。前者在麻醉后立即用0.3%葡萄糖酸氯己定进行阴道准备，而后者接受生理盐水冲洗。对参与者进行术后随访，在此期间观察每位参与者在入院时以及分娩后第8天和第14天的产褥期感染性疾病的临床特征。
与对照组相比，研究组子宫内膜炎的发生率和风险显著更低；分别为5.0%和13.3%（卡方=5.004；p=0.042，RR=0.38；95%CI=0.15-0.94；p=0.042；RRR=0.62）。研究组的术后发热和手术部位感染也低于对照组，但差异无统计学意义。
与安慰剂相比，剖宫产术前用0.3%氯己定溶液进行阴道准备仅显著降低了感染性疾病中术后子宫内膜炎的发生率和风险。
