Cesarean delivery (CD) is the most performed major surgery in women and surgical site infections following CD are a significant source of postoperative morbidity. It is unclear whether vaginal cleansing prior to cesarean delivery decreases post-cesarean infectious morbidity.
To evaluate whether preoperative vaginal cleansing with povidone-iodine among women undergoing CD after labor decreases post-operative infectious morbidity.
This randomized clinical trial was conducted from August 3, 2015 to January 28, 2021, with 30 days of follow-up, with final follow up completed February 27, 2021. Patients met inclusion criteria if they underwent CD after regular contractions with cervical dilation, rupture of membranes, or any CD performed at >4 cm dilation. Participants were randomly assigned in a 1:1 ratio to either abdominal cleansing plus vaginal cleansing with 1% povidone iodine or abdominal cleansing alone. The primary outcome was composite infectious morbidity including surgical-site infection, fever, endometritis, and wound complications within 30 days after CD. Secondary outcomes included individual components of the composite, length of hospital stay, postoperative hospitalization or outpatient treatment related to infectious morbidity, and empiric treatment for neonatal sepsis.
608 subjects (304 vaginal cleansing group, 304 control group) were included in the intention-to-treat analysis. Patient characteristics were similar between groups. There was no significant difference in the primary composite outcome between the two groups (11.8% vs 11.5%, p=0.90, RR 1.0; 95% CI 0.7, 1.6). Individual components of the composite and secondary outcomes were also not significantly different between groups. Similar findings were observed in the as-treated analysis (11.3% vs 11.8%, p=0.9, RR 1.0; 95% CI 0.7, 1.6).
Vaginal cleansing with povidone-iodine prior to unscheduled CD occurring after labor did not reduce postoperative infectious morbidity. These findings do not support the routine use of vaginal cleansing for women undergoing cesarean delivery after labor.

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