Taha T E, Biggar R J, Broadhead R L, Mtimavalye L A, Justesen A B, Liomba G N, Chiphangwi J D, Miotti P G
Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore MD 21205, USA.
BMJ. 1997 Jul 26;315(7102):216-9; discussion 220. doi: 10.1136/bmj.315.7102.216.
To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally.
Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention.
Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi.
A total of 6965 women giving birth in a six month period and their 7160 babies.
Manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine.
Effects of the intervention on neonatal and maternal morbidity and mortality.
3635 women giving birth to 3743 babies were enrolled in the intervention phase and 3330 women giving birth to 3417 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced (634/3743 (16.9%) v 661/3417 (19.3%), P < 0.01), as were admissions for neonatal sepsis (7.8 v 17.9 per 1000 live births, P < 0.0002), overall neonatal mortality (28.6 v 36.9 per 1000 live births, P < 0.06), and mortality due to infectious causes (2.4 v 7.3 per 1000 live births, P < 0.005). Among mothers receiving the intervention, admissions related to delivery were reduced (29.4 v 40.2 per 1000 deliveries, P < 0.02), as were admissions due to postpartum infections (1.7 v 5.1 per 1000 deliveries, P = 0.02) and duration of hospitalisation (Wilcoxon P = 0.008).
Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality.
确定分娩时用消毒剂清洁产道是否能降低母婴产后感染率。
临床试验；两个月无干预期，随后三个月为干预期，最后一个月为无干预期。
马拉维布兰太尔伊丽莎白女王中心医院（城市三级护理医院）。
六个月内分娩的6965名妇女及其7160名婴儿。
在分娩前每次阴道检查时，用0.25%的氯己定溶液手动擦拭产妇产道。干预期出生的婴儿也用氯己定擦拭。
干预措施对新生儿和产妇发病率及死亡率的影响。
3635名分娩3743名婴儿的妇女进入干预期，3330名分娩3417名婴儿的妇女进入非干预期。母亲及其子女中未出现与干预相关的不良反应。在干预期出生的婴儿中，总体新生儿入院率降低（634/3743（16.9%）对661/3417（19.3%），P<0.01），新生儿败血症入院率降低（每1000例活产中7.8例对17.9例，P<0.0002），总体新生儿死亡率降低（每1000例活产中28.6例对36.9例，P<0.06），感染性病因导致的死亡率降低（每1000例活产中2.4例对7.3例，P<0.005）。在接受干预的母亲中，与分娩相关的入院率降低（每1000例分娩中29.4例对40.2例，P<0.02），产后感染入院率降低（每1000例分娩中1.7例对5.1例，P=0.02），住院时间缩短（Wilcoxon检验P=0.008）。
用氯己定清洁产道可减少早期新生儿和产妇产后感染问题。该方法安全、简便且成本低，建议将其作为降低母婴发病率和死亡率的标准护理措施。
