• Users Online: 54
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 1  |  Page : 39-41

Effect of vaginal scrubbing on post-C-section infection


1 Department of Gynae, Category-D Hospital, Peshawar, Pakistan
2 Department of Gynae, DHQ Hospital, Upper Dir, KPK, Pakistan

Date of Submission19-Jan-2022
Date of Acceptance14-Feb-2022
Date of Web Publication26-Mar-2022

Correspondence Address:
Seema-Gul Salman
House No. 5, Street H, Danish Abad, Peshawar, KPK
Pakistan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hmj.hmj_5_22

Rights and Permissions
  Abstract 


Aims: The aim was to study the effect of vaginal scrubbing on post-C-section infection. Settings and Design: This was a randomised controlled trial. Subjects and Methods: This study was carried out from January 2019 to January 2021 on 434 patients who were divided into two groups: Group 0 which received abdominal and vulval scrubbing with povidone-iodine and Group 1 which also received vaginal scrubbing. Patients were monitored for any infection from the time of C-section to 30-day post-operative. Results: The mean ages of patients in Groups 0 and 1 were 27.15 ± 8.11 and 28.27 ± 8.14 years, respectively. Pyrexia was noted in 45 (10.4%) patients of Group 0 and 22 (5.1%) patients of the second group, respectively, with P = 0.01. Surgical site infection was noted in 22 (5.1%) patients of Group 0 and 21 (4.8%) patients of Group 1, P = 0.8. Endometritis occurred in 27 (6.2%) patients of Group 0 and 12 (2.8%) patients of Group 1; P = 0.01. Conclusions: Vaginal scrubbing reduces post-C-section infection.

Keywords: Caesarean section, infection, endometritis, vaginal scrubbing


How to cite this article:
Salman SG, Rafiq M. Effect of vaginal scrubbing on post-C-section infection. Hamdan Med J 2022;15:39-41

How to cite this URL:
Salman SG, Rafiq M. Effect of vaginal scrubbing on post-C-section infection. Hamdan Med J [serial online] 2022 [cited 2022 May 28];15:39-41. Available from: http://www.hamdanjournal.org/text.asp?2022/15/1/39/340820




  Introduction Top


Caesarean section is one of the most common obstetrical operations. Its rates are, 30–32% in U. S, 25.5% U. K and in Pakistan 46.7%.[1],[2],[3] In both emergency and elective settings, the feto-maternal outcome is affected by post-caesarean infection in addition to other factors.[4] This includes fever,[5] surgical site infection (SSI)[6] and endometritis[7] among other complications. These occur more frequently in third-world countries, including Pakistan, due to poor surgical standards.[8] Lower segment caesarean section (LSCS) is usually performed, especially in the emergent setting.[9]

The most common infectious complications occurring after LSCS include pyrexia, endometritis and SSI. The usual rates for these complications in a western setting are 12%, 4.7% and 3%, respectively.[10] For Pakistan, these rates are much higher.[11] Endometritis can be 20 times more common after C-section as opposed to normal vaginal delivery.[12] Post-caesarean infection leads to further complications, which can include dehiscence of wound, infection of urinary tract, disseminated intravascular coagulation and re-operation.[13] As a result, there are additional psychological, physical and economical burdens on the patient and health system.[14] About 3%–15% of wounds are infected post caesarean.[15] This can be reduced by various methods, including showering the day prior, clipping of hair, different interventional techniques and non-manual delivery of placenta and dilation of the cervix.[16] One of the most effective methods is asepsis.[17]

Vaginal scrubbing has been shown to reduce post-caesarean infections.[18] Povidone-iodine has been shown to be effective for this purpose.[19] Local studies on this subject are lacking. This study was carried out to find cost-effective and practical methods of reducing the rate of infections and associated complications after caesarean section.


  Subjects and Methods Top


This prospective randomised control trial was carried out from January 2019 to January 2021 after the hospital's ethical and research committee's approval and in accordance with the ethical principles mentioned in the Helsinki Declaration 2013. Only patients who consented to participate were studied. The WHO calculator for sample size was used with a 95% confidence interval and 0.05 significance level, resulting in a total sample of 434 patients. Exclusion criteria were comorbids, haemoglobin <7 g/dl, gestational diabetes, placenta praevia, obstruction of labour, pre-caesarean pyrexia and Prolonged premature rupture of membranes (PROM). Otherwise, all patients planned for caesarean were included in the study. Consecutive non-probability sampling was used. Allocation was planned with the use of a random number generator at scrubbing and not entered on the patient chart.

Patients were divided into two equal groups: Group 0 of 217 patients received abdominal and vulval scrubbing with povidone-iodine and Group 1 of a similar number of patients received the above in addition to vaginal scrubbing. Patients were monitored until 30-day post-operative for pyrexia, SSI and endometritis from the time of C-section. Discharged patients were communicated through telephone. Pyrexia was noted at a temperature above 100.4°F starting 24 h post-operative. SSI was determined by ASEPSIS criteria.[20] Endometritis was accepted as tender hypogastrium with foul lochia until the duration of follow-up. Prolonged rupture of membranes (PROM) was also noted.

Data was recorded on pre-formed proforma with data analysis on SPSS 23 (IBM Corporation, New York, USA). Quantitative data such as age and age of gestation were expressed as means and standard deviation. Qualitative data such as pyrexia SSI and endometritis were expressed as frequency and percentage. The two groups were compared using Chi-square test. Effect modifiers were controlled using stratification, and these included age, age of gestation, parity, duration of labour and PROM. In addition, post-stratification Chi-square was utilised. P ≤ 0.05 was accepted as statistically significant.


  Results Top


There were a total of 434 patients, of which we distributed them evenly into 217 patients each in Groups 0 and 1, respectively. Overall age (years) and age of gestation (weeks) were 27.71 ± 8.14 and 38.43 ± 1.64, respectively. In comparison, these values for Group 0 and 1 were 27.15 ± 8.11 versus 28.27 ± 8.14 years and 38.30 ± 1.67 versus 38.55 ± 1.60 weeks, respectively. Both of these were statistically insignificant, with P = 0.15 and 0.1, respectively.

In terms of pyrexia Group 0 had 45 (10.4%) cases versus 22 (5.1%) in Group 1, P = 0.01. Comparison in terms of SSI was 22 (5.1%) for Group 0 and 21(4.8%) for Group 1, P = 0.8 and the number of cases of endometritis was 27 (6.2%) in Group 0 versus 12 (2.8%) in Group 1, P = 0.01, respectively.

These are shown in [Table 1].
Table 1: Effect of vaginal scrubbing on post-C-section infection

Click here to view



  Discussion Top


The good perioperative management of the caesarean section requires frequent interventional procedures, including vaginal examinations. These coupled with natural factors such as PROM increase infection rates despite the use of perioperative broad-spectrum antibiotics.[21] Aref, among others, showed that vaginal scrubbing with povidone-iodine can reduce rates of infection.[18] Compared to the use of antibiotics for vaginal scrubbing as in the study by Till et al., among others, povidone-iodine has the advantage of no predisposition to antibiotic resistance.[21] Caissutti et al., among others, showed that 10% povidone-iodine was effective at controlling post-caesarean infection rates.[22] Roeckner et al., among others, showed that even a 1% concentration of povidone-iodine for vaginal scrubbing was the most effective preparation for the prevention of infections after caesarean section.[23] Other benefits include availability and cost-effectiveness. Aref, Caissutti et al. and Roeckner et al., among others, have shown that it has good tolerability and patient acceptance with minimal or no irritation or chemical reaction.[18],[22],[23]

In studies by Aref, Boyce, La Rosa et al., Caissutti et al. and Roeckner et al., it was shown that povidone-iodine reduced post-caesarean pyrexia and associated complication such as endometritis.[18],[19],[22],[23],[24] This is also supported by our present study where the use of povidone-iodine reduced pyrexia and endometritis between Groups 0 and 1, 45 (10.4%) versus 22 (5.1%) and 27 (6.2%) versus 12 (2.8%), respectively, showing a statistical significance at P = 0.01 for both. In the study by Aref, reduction in infections included overall infection dropped from 20.7% to 7.5% and endometritis 2.8% from 11.8%, respectively, with no change in pyrexia and SSI.[18] In the study by Asghania et al., reductions were endometritis 1.4% from 2.5%, with no change in pyrexia and SSI.[25] In the study by Starr et al., vaginal preparation was associated with endometritis at an odds ratio of 0.44, showing a significant decrease.[26] In the study by Ahmed et al., reduction included overall 8.8% from 24.4.% and endometritis 2.9% from 13.2%, respectively, with no change in pyrexia and rate of SSI.[27] Finally, in the study by Memon et al., the use of povidone-iodine was associated with overall reductions in both groups with odds ratio 0.335, endometritis reducing to 1% versus 7%, respectively but with no difference between the groups in terms of pyrexia and SSI.[28] Our study differs from above in which vaginal scrubbing resulted in the reduction of overall infection and endometritis but also of pyrexia: 45 (10.4%) versus 22 (5.1%), P = 0.01, respectively, with a similar status quo or no change for SSI: 22 (5.1%) versus 21 (4.8%), P = 0.8.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Clapp MA, Barth WH. The future of cesarean delivery rates in the United States. Clin Obstet Gynecol 2017;60:829-39.  Back to cited text no. 1
    
2.
Corso E, Hind D, Beever D, Fuller G, Wilson MJ, Wrench IJ, et al. Enhanced recovery after elective caesarean: A rapid review of clinical protocols, and an umbrella review of systematic reviews. BMC Pregnancy Childbirth 2017;17:91.  Back to cited text no. 2
    
3.
Naeem A, Answer A, Sajjad S. Caesarean section: Introduction and rate of caesarean section in Primigravida. Prof Med J 2018;25:1338-41.  Back to cited text no. 3
    
4.
Mascarello KC, Horta BL, Silveira MF. Maternal complications and cesarean section without indication: Systematic review and meta-analysis. Rev Saude Publica 2017;51:105.  Back to cited text no. 4
    
5.
Hofmeyr GJ, Smaill FM. WITHDRAWAN. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev 2010;(1):CD000933. PMID: 12137614. Available from: https://pubmed.ncbi.nlm.nih.gov/12137614/. [Last accessed on 2022 Mar 09].  Back to cited text no. 5
    
6.
Saeed KB, Corcoran P, Greene RA. Incisional surgical site infection following cesarean section: A national retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2019;240:256-60.  Back to cited text no. 6
    
7.
Smaill F, Hofmeyr GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev 2002;(3):CD000933. doi: 10.1002/14651858.CD007482. Available from: https://pubmed.ncbi.nlm.nih.gov/25350672/. [Last accessed on 2022 Mar 09].  Back to cited text no. 7
    
8.
CORONIS Trial Collaborative Group. The CORONIS Trial. International study of caesarean section surgical techniques: A randomised fractional, factorial trial. BMC Pregnancy Childbirth 2007;7:24.  Back to cited text no. 8
    
9.
Kiwan R, Al Qahtani N. Outcome of vaginal birth after caesarean section: A retrospective comparative analysis of spontaneous versus induced labour in women with one previous caesarean section. Ann Afr Med 2018;17:145-50.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Suonio S, Saarikoski S, Vohlonen I, Kauhanen O. Risk factors for fever, endometritis and wound infection after abdominal delivery. Int J Gynaecol Obstet 1989;29:135-42.  Back to cited text no. 10
    
11.
Kiani SA, Zafar M, Yasmin S, Mazhar SB. Vaginal cleansing prior to caesarean section and post-operative infectious morbidity. J Soc Obstet Gynaecol Pak 2018;8:95-9.  Back to cited text no. 11
    
12.
Carmona F, Cristóbal P, Casamitjana R, Balasch J. Effect of tubal sterilization on ovarian follicular reserve and function. Am J Obstet Gynecol 2003;189:447-52.  Back to cited text no. 12
    
13.
Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: A systematic review and meta-analysis. Arch Gynecol Obstet 2017;296:503-12.  Back to cited text no. 13
    
14.
Sway A, Nthumba P, Solomkin J, Tarchini G, Gibbs R, Ren Y, et al. Burden of surgical site infection following cesarean section in sub-Saharan Africa: A narrative review. Int J Womens Health 2019;11:309-18.  Back to cited text no. 14
    
15.
Kelekci S, Yorgancioglu Z, Yilmaz B, Yasar L, Savan K, Sonmez S, et al. Effect of tubal ligation on ovarian reserve and the ovarian stromal blood supply. Aust N Z J Obstet Gynaecol 2004;44:449-51.  Back to cited text no. 15
    
16.
Belaisch-Allart J, Mayenga JM, Castaing N, Allart JP. Is tubal and uterine surgery deleterious to ovarian reserve? Gynecol Obstet Fertil 2006;34:1111-7.  Back to cited text no. 16
    
17.
Dare FO, Bako AU, Ezechi OC. Puerperal sepsis: A preventable post-partum complication. Trop Doct 1998;28:92-5.  Back to cited text no. 17
    
18.
Aref NK. Vaginal cleansing prior to caesarian section: To do or not to do?: A randomized trial. J Gynecol Obstet Hum Reprod 2019;48:65-8.  Back to cited text no. 18
    
19.
Boyce JM. Best products for skin antisepsis. Am J Infect Control 2019;47S: A17-22.  Back to cited text no. 19
    
20.
Copanitsanou P, Kechagias VA, Grivas TB, Wilson P. Use of ASEPSIS scoring method for the assessment of surgical wound infections in a Greek orthopaedic department. Int J Orthop Trauma Nurs 2018;30:3-7.  Back to cited text no. 20
    
21.
La Rosa M, Jauk V, Saade G, Boggess K, Longo S, Clark EA, et al. Institutional protocols for vaginal preparation with antiseptic solution and surgical site infection rate in women undergoing cesarean delivery during labor. Obstet Gynecol 2018;132:371-6.  Back to cited text no. 21
    
22.
Till SR, Morgan DM, Bazzi AA, Pearlman MD, Abdelsattar Z, Campbell DA, et al. Reducing surgical site infections after hysterectomy: Metronidazole plus cefazolin compared with cephalosporin alone. Am J Obstet Gynecol 2017;217:187.e1-11.  Back to cited text no. 22
    
23.
Caissutti C, Saccone G, Zullo F, Quist-Nelson J, Felder L, Ciardulli A, et al. Vaginal cleansing before cesarean delivery: A systematic review and meta-analysis. Obstet Gynecol 2017;130:527-38.  Back to cited text no. 23
    
24.
Roeckner JT, Sanchez-Ramos L, Mitta M, Kovacs A, Kaunitz AM. Povidone-iodine 1% is the most effective vaginal antiseptic for preventing post-cesarean endometritis: A systematic review and network meta-analysis. Am J Obstet Gynecol 2019;221:261.e1-20.  Back to cited text no. 24
    
25.
Asghania M, Mirblouk F, Shakiba M, Faraji R. Preoperative vaginal preparation with povidone-iodine on post-caesarean infectious morbidity. J Obstet Gynaecol 2011;31:400-3.  Back to cited text no. 25
    
26.
Starr RV, Zurawski J, Ismail M. Preoperative vaginal preparation with povidone-iodine and the risk of postcesarean endometritis. Obstet Gynecol 2005;105:1024-9.  Back to cited text no. 26
    
27.
Ahmed MR, Aref NK, Sayed Ahmed WA, Arain FR. Chlorhexidine vaginal wipes prior to elective cesarean section: Does it reduce infectious morbidity? A randomized trial. J Matern Fetal Neonatal Med 2017;30:1484-7.  Back to cited text no. 27
    
28.
Memon S, Qazi RA, Bibi S, Parveen N. Effect of preoperative vaginal cleansing with an antiseptic solution to reduce post caesarean infectious morbidity. J Pak Med Assoc 2011;61:1179-83.  Back to cited text no. 28
    



 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Article Tables

 Article Access Statistics
    Viewed280    
    Printed16    
    Emailed0    
    PDF Downloaded47    
    Comments [Add]    

Recommend this journal