Effect of preoperative vaginal preparation with Povidone- Iodine on incidence of endometritis in cesarean delivery

Post cesarean endometritis and wound infection remain significant morbidities despite use of strategies to prevent these complications. Cesarean delivery is the most common major abdominal surgery. We investigated the effect of preoperative vaginal preparation with Povidone-Iodine on postcesarean endometritis and wound infections. In this randomized clinical trial، 526 women undergoing cesarean delivery were selected randomly. Exclusion criteria were: Preterm pregnancy، (GA<37)، placenta previa، severe anemia (Hct<30)، Chorioaminoitis، Diabetes، Meconium Amniotic Fluid، Obesity (w>114b Kg)، Multifetal gestation،Prolonged induction (>10h)، Arrest descending in station #0، Prolonged premature rupture of membranes (>18h). Subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotic at the time of umbilical cord. Each subject’s postoperative course was reviewed for development of endometritis (temperature #38. 4 accompanied by fundal tenderness occurring beyond the first postopereative day in the absence of evidence of other infection)، and wound infection. Postcesarean endometritis occurred in 3. 4% of subjects who received a preoperative vaginal preparation and 4. 6% of controls (P=0. 50). Wound infection occurred in 1. 5%of subjects who received preoperative vaginal preparation and 1. 9% of control. There was no measurable effect of a vaginal scrub on the development of postcesarean endometritis or wound infection. Preoperative vaginal scrub with povdone-iodine before cesarean had no effect on the incidence of endomeritis or wound infection.