The Effect of Vaginal Preparation with Povidone Iodine with Routine Abdominal Preparation on Post Cesarean Infection

Introduction & The most common complications of cesarean section are post operative fever and endometritis. This study was undertaken to assess the effect of preoperative vaginal preparation with povidone iodine on these complications. A double blind clinical trial study was conducted on 430 term singleton pregnant women who referred to obstetric department of Ali Ebne Abitaleb Hospital in Zahedan city in 2006-2007 for elective cesarean. All patients received prophylactic antibiotic after umbilical cord clamping. In the control group (215 cases) we did only abdominal scrub, but in the case group (215 cases) we did additional vaginal preparation with povidone iodine solution before the beginning of cesarean. The exclusion criteria were: placenta previa, gestational or overt diabetes mellitus, corticosteroids usage, morbid obesity and fever before and at cesarean, presence of bloody or meconium-stained amniotic fluid or prolonged surgery. We investigated the patients after first post operative day until removing surgical sutures for development of febrile morbidity (temperature>38°C), clinical symptoms and signs of endometritis (fever persisting in association with uterine tenderness and foul lochia, in the absence of physical or laboratory evidence of other infections), wound inflammation (erythematic or tenderness of wound edges), wound infection (signs of inflammation in association with purulent drainage). The statistical data were analyzed by the SPSS software and P.value <0.05 considered significant. There was no significant differentiation between the two groups regarding socioeconomic situation, weight, age, length, parity and time of operation. The results of our study showed that preparation with povidone iodine in elective cesarean before the beginning of surgery, significantly reduces the post operative fever (13.9% in the control group and 2.3% in the case group, P=0.0001) and post operative endometritis rate (10.2% in the control group and 1.9% in the case group, P=0.0001),wound inflammation(4% in the control group and 0.9% in the case group P=0.0009) and wound infection (2.3% in the control group and 0.9% in the case group, P=0.2). According to our findings, vaginal preparation with povidone-iodine before elective cesarean section effectively reduces post operation fever and endometritis.