Post-cesarean related infection and vaginal preparation with povidone–iodine revisited

Abstract

The objective of this study was to ascertain whether vaginal preparation with povidone-iodine before Cesarean delivery would reduce the incidence of post-Cesarean related infection. Participants were randomized to vaginal preparation with either povidone-iodine (n = 80) or saline (n = 80). Post-cesarean related infections included 1) endometritis, defined as fever of >100.4°F on two separate occasions, 6 hours apart, >24 hours postoperatively or >101°F at any time with abdominal/uterine tenderness or 2) cellulitis, defined as advancing erythema around the incision. We calculated overall rates of post-cesarean related infection, relative risk, and 95% confidence intervals for the effect of vaginal preparation. As designed and reported, the trial had at least an 85% power to detect a 30% or greater absolute difference in rates of overall infection (two tailed, α = 0.05). There was no significant difference among group demographics (maternal age, parity, anesthesia, labor before current cesarean delivery, number of vaginal examinations during labor, prophylactic antibiotic use, or gestational age at delivery). The post-cesarean endometritis rate was (9.4%). The post-cesarean cellulitis rate was (6.8%). Vaginal preparation with povidone-iodine before Cesarean delivery reduced the rate of post-cesarean endometritis (P < .04). The rates of post-cesarean cellulitis between the two groups were similar (P = .12). In our study, vaginal preparation with povidone-iodine before cesarean delivery significantly reduced the incidence of post-cesarean endometritis but not of cellulitis.