دورية أكاديمية
أعرض في EDS

Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.

التفاصيل البيبلوغرافية
العنوان: Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.
المؤلفون: Ogah CO; Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria., Anikwe CC; Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria., Ajah LO; Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria., Ikeotuonye AC; Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria., Lawani OL; Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria., Okorochukwu BC; Department of Obstetrics and Gynecology, Federal Medical Center, Owerri, Nigeria., Ikeoha CC; Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria., Okoroafor FC; Department of Obstetrics and Gynecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
المصدر: Acta obstetricia et gynecologica Scandinavica [Acta Obstet Gynecol Scand] 2021 Apr; Vol. 100 (4), pp. 694-703. Date of Electronic Publication: 2021 Jan 23.
نوع المنشور: Journal Article; Randomized Controlled Trial
اللغة: English
بيانات الدورية: Publisher: Wiley Country of Publication: United States NLM ID: 0370343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-0412 (Electronic) Linking ISSN: 00016349 NLM ISO Abbreviation: Acta Obstet Gynecol Scand Subsets: MEDLINE
أسماء مطبوعة: Publication: 2011- : Malden, MA : Wiley
Original Publication: Copenhagen : Munksgaard
مواضيع طبية MeSH: Cesarean Section*, Anti-Infective Agents, Local/*administration & dosage , Chlorhexidine/*administration & dosage , Surgical Wound Infection/*prevention & control, Administration, Intravaginal ; Female ; Humans ; Nigeria ; Pregnancy ; Preoperative Care ; Prospective Studies
مستخلص: Introduction: Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities.
Material and Methods: This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections.
Results: Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P < .05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species.
Conclusions: Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.
(© 2020 Nordic Federation of Societies of Obstetrics and Gynecology.)
References: Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in cesarean section rates: global, regional, and national estimates: 1990-2014. PLoS ONE. 2016;11:e0148343.
Robson SJ, de Costa CM. Thirty years of the World Health Organization’s target cesarean section rate: time to move on. Med J Aust. 2017;206:181-185.
Asiegbu OG, Asiegbu UV, Mamah EJ, Anikwe CC, Ogah OE, Nnadozie UU. Determinants and outcomes of elective and emergency caesarean section at a tertiary hospital in Abakaliki, Southeast Nigeria: a 6-year review. Trop J Obstet Gynaecol. 2019;36:200-205.
Boatin AA, Schlotheuber A, Betran AP, et al. Within country inequalities in cesarean section rates: observational study of 72 low and middle-income countries. BMJ. 2018;360:k55.
Harrison MS, Goldenberg RL. Cesarean section in sub-Saharan Africa. Matern Health Neonatol Perinatol. 2016;2:6.
Ugwu EO, Obioha KC, Okezie OE, Ugwu AO. A five-year survey of cesarean delivery at a Nigerian tertiary hospital. Ann Med Health Sci Res. 2011;1:77-84.
Ojiyi EE, Dike EI, Anolue F, Chukwulebe A. Appraisal of cesarean section at the Imo State University Teaching Hospital, Orlu, South-Eastern Nigeria. Int J Gynaecol Obstet. 2012;16:2.
Daniel CN, Singh S. Cesarean delivery: an experience from a tertiary institution in North-Western Nigeria. Niger J Clin Pract. 2016;19:18-24.
Gelaw KA, Aweke AM, Astawesegn FH, Demissie BW, Zeleke LB. Surgical site infection and its associated factors following cesarean section: a cross-sectional study from a public hospital in Ethiopia. Patient Saf Surg. 2017;11:18.
Adeyinka A, Egagifo O, Igberase GO. Review of cesarean delivery infection in Nigeria. Ann Clin Case Rep. 2018;3:1518.
Zejnullahu VA, Isjanovska R, Sejfija Z, Zejnullahu VA. Surgical site infections after cesarean sections at the University Clinical Center of Kosovo: rates, microbiological profile, and risk factors. BMC Infect Dis. 2019;19:752.
Anthony JR. Maternal mortality: preventing tragedy in developing countries. Can Fam Physician. 1990;36:87-91.
Oladapo OT, Adetoro OO, Ekele BA, et al. Nigeria Near-miss and Maternal Death Surveillance Network. When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country. BJOG. 2016;123:928-938.
Redshaw M, van den Akker O. Understanding factors which can influence the experience of pregnancy and childbirth. J Reprod Infant Psychol. 2008;26:71-73.
Chepchirchir M, Nyamari J, Keraka M. Associated factors with puerperal sepsis among reproductive age women in Nandi County, Kenya. J Midwifery Reproductive Health. 2017;5:1032-1040.
Osborn NG, Wright RC. Effect of preoperative scrub on the bacteria flora of the endo-cervical and vagina. Obstet Gynaecol. 1977;50:148-150.
Memon S, Qazi RA, Bibi S, Parveen N. Effect of preoperative vaginal cleansing with an antiseptic solution to reduce post-cesarean infectious morbidity. J Pak Med Assoc. 2011;61:1179-1183.
Rouse DJ, Hauth JC, Andrews WW, Mills BB, Maher JE. Chlorhexidine vaginal irrigation for the prevention of perinatal infection: a placebo-controlled randomized clinical trial. Am J Obstet Gynecol. 1997;176:617-622.
Luke CM, Gary LD, James MT. Safety and impact of chlorhexidine antisepsis intervention for improving neonatal health in developing countries. Pediatr Infant Disease J. 2006;25:665-675.
Hass DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before cesarean section for prevention of post-operative infection. Cochrane Database Syst Rev. 2014;(12):CD007892.
Ezegwui HU, Onoh RC, Ikeakor LC, Onyebuchi AK, Umeora OUJ. Investigating maternal mortality in a Public Teaching Hospital in Abakaliki, Ebonyi State, Nigeria. Ann Med Health Sci Res. 2013;3:75-80.
Anikwe CC, Egbuji CC, Ejikeme BN, et al. The experience of women following cesarean section in a tertiary hospital in SouthEast Nigeria. Afri Health Sci. 2019;19:2660-2669.
Blevins M. Sample Size Planning, Calculation, and Justification. http://biostat.mc.vanderbilt.edu/wiki/pub/Main/BlevinsMPH/SAMPLE&#95;SIZE.pdf. Assessed 23 June 2020.
Mohamed HES, Hassan SI, Hemida R. Vaginal preparation with antiseptics solution before cesarean section for reduction of post-partum morbidity. Cochrane Database System Rev. 2015;(4):75-80.
Surgical Site Infection (SSI) Event - CDC. https://www.cdc.gov/nhsn/pdfs/pscManual/9pscSSIcurrent.pdf. Assessed 14 June 2020.
Kifilie AB, Dagnew M, Tegenie B, et al. Bacterial profile, antibacterial resistance pattern, and associated factors from women attending postnatal health service at University of Gondar Teaching Hospital, Northwest Ethiopia. Int J Microbiol. 2018;2018:10.
Caissutti C, Saccone G, Zullo F, et al. Vaginal cleansing before cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol. 2017;130:527-538.
Hugo WB, Longworth AR. Some aspects of the mode of action of chlorhexidine. J Pharm Pharmacol. 1964;16:655-662.
Lakhi NA, Tricorico G, Osipova Y, Moretti ML. Vaginal cleansing with chlorhexidine gluconate or povidone-iodine before cesarean delivery: a randomized comparator-controlled trial. Am J Obstet Gynecol MFM. 2019;1:2-9.
Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD. Williams Obstetrics, 21st edn. London: McGraw-Hill; 2001:675.
Aref NK. Vaginal cleansing before caesarian section: to do or not to do? A randomized trial. J Gynecol Obstet Hum Reprod. 2019;48:65-68.
Starr RV, Zurawski J, Ismail M. Preoperative vaginal preparation with povidone-iodine and the risk of post-cesarean endometritis. Obstet Gynecol. 2005;105:1024-1029.
Ahmed MR, Aref NK, Sayed Ahmed WA, Arain FR. Chlorhexidine vaginal wipes prior to the elective cesarean section: does it reduce infectious morbidity? A randomized trial. J Matern Fetal Neonatal Med. 2017;30:1484-1487.
Davies A. The mode of action of chlorhexidine. J Periodontal Res. 1973;12:68-75.
Kaur A, Singh K, Pannu K, Singh P, Sehgal N, Kaur R. The effect of exclusive breastfeeding on hospital stay and morbidity due to various diseases in infant under 6 months of age. A prospective observational study. Int J Pediatr. 2016;2016:7647054.
USAID. Intersecting epidemics: an overview of the causes of maternal death and infectious diseases. https://www.mchip.net/sites/default/files/Maternal%20Health&#95;Infectious%20Diseases%20Overview%20Briefer.pdf. Assessed 12 June 2020.
Agboeze J, Onoh RC, Umerora OUJ, et al. Microbiology pattern of post-cesarean section wound infection at Federal Teaching Hospital, Abakaliki. Afr J Med Health Sci. 2013;12:99-102.
Njoku CO, Njoku AN. Microbiological pattern of surgical site infection following cesarean section at the University of Calabar Teaching Hospital. Open Access Maced J Med Sci. 2019;7:1430-1435.
Kaplan NM, Smadi AA, Al-Taani MI, El-Qudah MA. Microbiology of wound infection after cesarean section in a Jordanian hospital. Eastern Mediterranean Health J. 2003;9:1068-1074.
De D, Saxena S, Mehta G, Yadav R, Dutta R. Risk factor analysis and microbial etiology of surgical site infections following lower segment cesarean section. Int J Antibiot. 2013;6.
Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following cesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control. 2014;3:25.
Isanga J, Emmanuel B, Musa K, Julius M, Tibaijuka L, Ronald M. The prevalence, risk factors, and bacterial profile of cesarean surgical site infections at a University Teaching Hospital in South Western Uganda. Int J Women's Health Care. 2020;1:5-10.
فهرسة مساهمة: Keywords: cesarean section; chlorhexidine; endometritis; postoperative; vaginal cleansing
المشرفين على المادة: 0 (Anti-Infective Agents, Local)
R4KO0DY52L (Chlorhexidine)
تواريخ الأحداث: Date Created: 20201222 Date Completed: 20210428 Latest Revision: 20210428
رمز التحديث: 20231215
DOI: 10.1111/aogs.14060
PMID: 33351989
قاعدة البيانات: MEDLINE
الوصف
تدمد:1600-0412
DOI:10.1111/aogs.14060