Vaginal disinfection before cesarean delivery in preventing postoperative infections:a meta-analysis

Objective To analyze the efficacy of vaginal disinfection with povidone-iodine before cesarean delivery in preventing postoperative infections.Methods Randomized controlled trials,identified from a systematic search of relevant databases including PubMed,EMBASE,CBM,CNKI,and CQVIP,were screened and evaluated according to standardized criteria.RevMan 5.2software was used to do the meta-analysis.Results A total of 9randomized controlled trials with 3 024 participants,with 1 508 in the vaginal cleansing group and 1 516 in the control group,were included in this meta-analysis.The analysis result showed that vaginal disinfection with povidone-iodine before cesarean delivery reduced the incidence of postcesarean endometritis(RR=0.55,95% CI 0.36-0.85,P =0.007).The incidence of post-cesarean endometritis was significantly reduced in women with ruptured membranes(RR=0.29,95%CI:0.16-0.52,P0.000 1)and women in labor(RR=0.63,95%CI 0.41-0.96,P=0.03),but not significantly reduced in the women with intact membranes(RR=0.73,95%CI 0.50-1.08,P=0.11)or women not in labor(RR=0.79,95%CI 0.53-1.17,P=0.24).Vaginal disinfection could not help to reduce the incidence of postoperative wound infection(RR=0.80,95%CI 0.53-1.22,P=0.30)or postoperative fever(RR=0.92,95%CI 0.76-1.11,P=0.37).Conclusion Vaginal disinfection with povidone-iodine before cesarean delivery can decrease the risk of post-cesarean endometritis,especially for women undergoing cesarean delivery with ruptured membranes or in labor,but vaginal disinfection do not reduce the risk of postoperative wound infection or fever.