Authors
Lawal SO, Okome GB, Ehidiamen SE, Ikheloa J, Momoh M, and Ameh N.
Abstract
Infectious morbidity is the most common complication of caesarean section. Despite routine antibiotic prophylaxis, post-caesarean infectious morbidity remains a significant source of maternal morbidity, particularly in Nigeria. Preoperative vaginal antisepsis is recommended as an adjunctive preventive measure; however, comparative data on Chlorhexidine-Cetrimide versus the WHO-recommended Povidone-Iodine are scarce.
Objective: To compare the efficacy of preoperative vaginal cleansing with 0.3% Chlorhexidine-3% Cetrimide (CC) versus 10% Povidone-Iodine (PI) in the prevention of post-caesarean section composite infectious morbidity.
Methods: A prospective, double-blinded, randomised controlled trial was conducted at Irrua Specialist Teaching Hospital, Nigeria. One hundred and seventy-eight women undergoing caesarean section were randomised 1:1 to CC ($n=90$) or PI ($n=88$) preoperative vaginal cleansing. Primary outcome was composite infectious morbidity (endometritis, febrile morbidity, and/or wound infection). Follow-up was to six weeks postpartum.
Results: Composite infectious morbidity occurred in 4.4% of the CC arm versus 9.9% in the PI arm (RR 0.44; 95% CI 0.20-0.57; $p=0.012$). CC was associated with significantly lower rates of clinical endometritis (1.1% vs. 3.4%; RR 0.32; $p=0.034$), febrile morbidity (1.1% vs. 2.3%; RR 0.49; $p=0.023$), and wound infection (3.3% vs. 4.5%; RR 0.73; $p=0.041$). Neonatal outcomes and tolerability were comparable in both arms.
Conclusion: Chlorhexidine-Cetrimide demonstrated statistically significant superiority over Povidone-Iodine in preventing post-caesarean infectious morbidity. Both agents were well tolerated. Chlorhexidine-Cetrimide should be considered as an alternative preoperative vaginal antiseptic for caesarean section.
Objective: To compare the efficacy of preoperative vaginal cleansing with 0.3% Chlorhexidine-3% Cetrimide (CC) versus 10% Povidone-Iodine (PI) in the prevention of post-caesarean section composite infectious morbidity.
Methods: A prospective, double-blinded, randomised controlled trial was conducted at Irrua Specialist Teaching Hospital, Nigeria. One hundred and seventy-eight women undergoing caesarean section were randomised 1:1 to CC ($n=90$) or PI ($n=88$) preoperative vaginal cleansing. Primary outcome was composite infectious morbidity (endometritis, febrile morbidity, and/or wound infection). Follow-up was to six weeks postpartum.
Results: Composite infectious morbidity occurred in 4.4% of the CC arm versus 9.9% in the PI arm (RR 0.44; 95% CI 0.20-0.57; $p=0.012$). CC was associated with significantly lower rates of clinical endometritis (1.1% vs. 3.4%; RR 0.32; $p=0.034$), febrile morbidity (1.1% vs. 2.3%; RR 0.49; $p=0.023$), and wound infection (3.3% vs. 4.5%; RR 0.73; $p=0.041$). Neonatal outcomes and tolerability were comparable in both arms.
Conclusion: Chlorhexidine-Cetrimide demonstrated statistically significant superiority over Povidone-Iodine in preventing post-caesarean infectious morbidity. Both agents were well tolerated. Chlorhexidine-Cetrimide should be considered as an alternative preoperative vaginal antiseptic for caesarean section.
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