Randomized study of vaginal chlorhexidine disinfection during labor to prevent vertical transmission of group B streptococci (original) (raw)
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Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection
The Cochrane database of systematic reviews, 2014
Although early-onset group B β-hemolytic streptococcus (GBS) infection is rare, it accounts for approximately 30% of neonatal infections, has a high mortality rate, and is acquired through vertical transmission from colonized mothers. Several trials have demonstrated the efficacy of intrapartum antibiotic prophylaxis (IAP) for preventing early-onset disease (EOD). Vaginal disinfection with chlorhexidine during labour has been proposed as another strategy for preventing GBS EOD in the preterm and term neonate. Chlorhexidine has been found to have no impact on antibiotic resistance, is inexpensive, and applicable to poorly equipped delivery sites. To determine the effectiveness of vaginal disinfection with chlorhexidine during labour in women who are colonized with GBS for preventing early-onset GBS infection in preterm and term neonates. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014) and reference lists of retrieved studies. Randomized...
Abstract Objective: To evaluate the efficacy of preoperative vaginal cleansing using chlorhexidine 0.25% antiseptic wipes on rates of postcesarean section (CS) infectious morbidities (endometritis, febrile morbidity and wound infection). Methods: This prospective randomized trial was conducted among 218 pregnant women scheduled for term elective CS. Patients were equally divided into two groups by simple randomization. After spinal anesthesia and catheterization under aseptic technique, the study group had preoperative vaginal cleansing using chlorhexidine 0.25% antiseptic wipes for about 1 min, while the control group did not. All cases received the prophylactic antibiotics and the usual abdominal scrub. All participants received the routine postoperative care without other interventions. Adverse postcesarean infectious morbidities such as endometritis, febrile morbidity and wound infection were observed at the time of hospital discharge and weekly for 6 weeks postpartum. Results: Both groups were matched regarding the baseline patients’ characteristics (age, gestational age, BMI, operative time and postoperative hospital stay). Overall, post-CS infectious morbidity were significantly reduced from 24.4% in the control group to 8.8% in the intervention group; p value50.05. Marked reduction was seen in the incidence of endometritis (13.2% in the control group versus 2.9% in the intervention group; p value50.05). However, fever and wound infection showed no significant difference between both groups. Conclusion: Cleansing the birth canal with chlorhexidine 0.25% wipes prior to elective CS appears to be effective in reducing rates of post
Acta Obstetricia et Gynecologica Scandinavica
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 chlorhexidinealcohol. 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 | 695 OGAH et Al.
International Journal of Medical Arts, 2022
Article information Background: Cesarean delivery is the commonest surgical procedure practiced by Obstetricians and its incidence continues to rise. It is associated with significant morbidity, and infection is one of the most common postoperative complications. Different interventions are described to decrease the rate of infection. The use of vaginal antiseptics and antimicrobial was prescribed. However, the results are inconsistent. The aim of the work: The current work aimed to determine the value of pre-surgical vaginal cleaning by a 5% chlorhexidine gluconate solution could reduce the risk of maternal infections after cesarean delivery. Patients and Methods: This study included 400 women attending obstetrics and gynecology departments to deliver by elective cesarean section. The study had been completed between the beginning of January 2019 to the end of December 2021. All women were randomized to one of two equal groups. The first included 200 women where no wash was done [Control group]. The second included another 200 cases where wash with chlorhexidine gluconate was done [Study group]. At the time of hospital discharge and again at one month post delivery. The rate of endometritis and different wound complications were documented and compared between groups. Results: The control and study groups were comparable regarding female age, parity, gestational age at delivery, primary cesarean section, operative time. However, postoperative hospital stay duration was significantly longer in control than the study group [43.26±10.62 vs. 39.69±9.21 hours, respectively]. Hemoglobin concentrations revealed non-significant difference between the study and the control groups before and after cesarean delivery. However, it was significantly reduced in both groups after surgery than values before surgery. Endometritis was reported among 12.5% of the control group, compared to 7.0% of the study group, with no significant difference between the study and the control groups. However, the overall wound complications were significantly increased among control than study group and composite complications were also significantly increased in control than the study group [12.0% vs 4.0% respectively]. Lower preoperative hemoglobin was the only significant associated factor for development of endometritis. Conclusion: Peroperative vaginal preparation with 5.0% chlorhexidine gluconate solution is associated with a reduction in post-cesarean infectious complications [mainly endometritis] wound infection and other wound-related complications. It is recommended to be a routine practice before cesarean delivery.
The association of preterm labor with vaginal colonization of group B streptococci
Iran J Reprod med, 2007
Iranian Journal of Reproductive Medicine Vol.5. No.4. pp: 191-194, Autumn 2007 ... The association of preterm labor with vaginal ... Bibi Shahnaz Aali1 MD, Hamid Abdollahi2 Ph.D., Nouzar Nakhaee3 MD, MPH, Zohreh Davazdahemami3 B.Sc., Anahita Mehdizadeh4 B.Sc. ... 1 Departmentn of Obstetrics and Gynecology, Physiology Research Center, Kerman University of Medical Sciences, kerman, Iran. 2 Department of Microbiology, Kerman University of Medical sciences. 3 Kerman University of Medical sciences, Kerman, Iran. 4 Departmant of ...
Randomized study of vaginal and neonatal cleansing with 1% chlorhexidine
International Journal of Gynecology & Obstetrics, 2011
Objective: To determine the safety, acceptability, and antimicrobial effect of 1% chlorhexidine (CHX) vaginal washing of women in labor and their neonates. Methods: Randomized controlled trial of 1% CHX vaginal and neonatal washing compared with no washing (usual care [UC]). The study included 502 women (334 CHX, 168 UC) who delivered 508 liveborn neonates (335 CHX, 173 UC). Main outcome measures were the incidence of maternal adverse effects, the incidence of neonatal skin rash, the axillary temparature before and after neonatal wiping, and vaginal culture results. Results: Maternal demographics did not differ between the groups. No case of maternal rash occured; 4% of women experienced vaginal burning. An axillary temperature drop of more than 1°C after CHX cleansing occurred in 8 neonates; 2 neonates had a minor rash. In the subset of women with positive vaginal cultures as baseline, 1% CHX eliminated culture growth in 56% after 1 wash, and in 86% after 2 washes. Conclusions: Use of 1% CHX is safe for neonates, well tolerated by laboring mothers, and effective in treating vaginal infections during labor. A randomized controlled trial using 1% CHX and powered for a reduction in neonatal septic mortality is justified based on these data.