Ugadu Ikechukwu Ogwudu, Egede John Okafor, Nwigboji Wilson Ndukwe, Igwe Chinyere Peace, Nwali Alegu Silas, Adebayo Joshua Adeniyi, Umeora Odidika U J
National Obstetrics Fistula Centre, Abakaliki, Ebonyi State, Nigeria.
Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
J West Afr Coll Surg. 2022 Oct-Dec;12(4):64-74. doi: 10.4103/jwas.jwas_159_22. Epub 2022 Nov 23.
Post-caesarean maternal infectious morbidity is still a big challenge despite prophylactic antibiotics use and other modalities adopted to prevent it. Pre-operative or post-operative vaginal cleansing with povidone-iodine may have effect on post-caesarean maternal infectious morbidity.
The aim of this study was to compare the effectiveness of pre-operative vs. post-operative vaginal cleansing with povidone-iodine in reducing post-caesarean maternal infectious morbidities in a teaching hospital, South East Nigeria.
This was a randomized controlled trial involving 244 pregnant women who underwent elective or emergency lower segment caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Recruited patients were randomized into two groups: Group 1 had pre-operative vaginal cleansing with 5% povidone-iodine, whereas group 2 had post-operative vaginal cleansing with 5% povidone-iodine. Post-operatively, patients were monitored for clinical symptoms and signs of endometritis, wound infection, and pyrexia daily till discharge and at 2 weeks post-partum visit. Both groups received same post-operative care.
Data were analysed using Statistical Package for Social Sciences (IBM SPSS) software (version 20, Chicago, IL, USA). Continuous variables were presented as mean and standard deviation (mean ± 2SD), whereas categorical variables were presented as numbers, frequencies, and percentages. The -test was used for comparison between groups for quantitative variables, whereas the χ test was used to compare categorical variables. Relative risk and 95% confidence interval were calculated for outcome measures. -value<0.05 was considered significant.
The overall infectious morbidity rate was 14.3% (34/239) in all the study participants. The rate was 1.7% (4/239) among women in the pre-operative vaginal cleansing group and 12.6% (30/239) among women in the post-operative vaginal cleansing group. This was statistically significant [( < 0.05); relative risk (RR) 0.13, 95% confidence interval (CI) 0.05-0.36]. Endometritis occurred in 13/239 (5.4%) women with 0.8% in the pre-operative group and 4.6% in the post-operative vaginal cleansing group. This was also statistically significant ( = 0.009; RR 0.18, 95% CI 0.04-0.78). Wound infection occurred in 11/239 (4.6%) women with 0.8% in the pre-operative group and 3.8% in the post-operative vaginal cleansing group ( = 0.032; RR 0.22, 95% CI 0.05-0.98). Pyrexia occurred in 10/239 (4.2%) women with 0 (0%) in the pre-operative group and 4.2% in the post-operative vaginal cleansing group. This was also statistically significant ( = 0.0007; RR 0.01, 95% CI 0.007-0.16). These were commoners among women with ruptured foetal membranes ( =0.001; RR 0.22, CI 0.08-0.61) and those who had emergency caesarean delivery (=0.0001; RR 0.14, CI 0.05-0.37).
Pre-operative vaginal cleansing with povidone-iodine is more effective in the reduction of composite post-caesarean maternal infectious morbidity compared with immediate post-operative vaginal cleansing with povidone-iodine, especially in women with ruptured foetal membranes and those who had emergency caesarean section.
尽管使用了预防性抗生素以及采取了其他预防措施，但剖宫产术后产妇的感染性疾病仍是一个重大挑战。术前或术后用聚维酮碘进行阴道清洁可能会对剖宫产术后产妇的感染性疾病产生影响。
本研究的目的是比较在尼日利亚东南部一家教学医院中，术前与术后用聚维酮碘进行阴道清洁在降低剖宫产术后产妇感染性疾病方面的效果。
这是一项随机对照试验，涉及244名在尼日利亚阿巴卡利基的亚历克斯·埃克乌梅联邦大学教学医院接受择期或急诊下段剖宫产的孕妇。招募的患者被随机分为两组：第1组在术前用5%聚维酮碘进行阴道清洁，而第2组在术后用5%聚维酮碘进行阴道清洁。术后，每天对患者进行监测，观察子宫内膜炎、伤口感染和发热的临床症状和体征，直至出院以及产后2周复诊时。两组接受相同的术后护理。
使用社会科学统计软件包（IBM SPSS）软件（版本20，美国伊利诺伊州芝加哥）进行数据分析。连续变量以均值和标准差（均值±2标准差）表示，而分类变量以数字、频率和百分比表示。采用t检验对定量变量进行组间比较，而χ²检验用于比较分类变量。计算结局指标的相对风险和95%置信区间。P值<0.05被认为具有统计学意义。
所有研究参与者的总体感染发病率为14.3%（34/239）。术前阴道清洁组女性的发病率为1.7%（4/239），术后阴道清洁组女性的发病率为12.6%（30/239）。这具有统计学意义（P<0.05）；相对风险（RR）为0.13，95%置信区间（CI）为0.05 - 0.36。13/239（5.4%）的女性发生了子宫内膜炎，术前组为0.8%，术后阴道清洁组为4.6%。这也具有统计学意义（P = 0.009；RR 0.18，95% CI 0.04 - 0.78）。11/239（4.6%）的女性发生了伤口感染，术前组为0.8%，术后阴道清洁组为3.8%（P = 0.032；RR 0.22，95% CI 0.05 - 0.98）。10/239（4.2%）的女性出现了发热，术前组为0（0%），术后阴道清洁组为4.2%。这也具有统计学意义（P = 0.0007；RR 0.01，95% CI 0.007 - 0.16）。这些在胎膜破裂的女性中更为常见（P = 0.001；RR 0.22，CI 0.08 - 0.61）以及那些进行急诊剖宫产的女性中（P = 0.0001；RR 0.14，CI 0.05 - 0.37）。
与术后立即用聚维酮碘进行阴道清洁相比，术前用聚维酮碘进行阴道清洁在降低剖宫产术后产妇综合感染发病率方面更有效，尤其是在胎膜破裂的女性和进行急诊剖宫产的女性中。
