Implementation of vaginal cleansing prior to cesarean delivery to decrease endometritis rates. (18th June 2019)

• Record Type: Journal Article
• Authors: Felder, Laura; Paternostro, Amanda; Quist-Nelson, Johanna; Baxter, Jason; Berghella, Vincenzo
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 32:Number 12(2019)
• Page Start: 1997
• Page End: 2002
• Publication Date: 2019-06-18
• Subjects: Betadine -- cesarean delivery -- endometritis -- pregnancy -- vaginal cleansing -- vaginal preparation; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2017.1422717
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Background: Endometritis is a postpartum complication that is more common after cesarean delivery. It frequently requires intravenous antibiotic administration, prolonged hospital stays, and carries a risk of sepsis or abscess formation. Precesarean vaginal preparation has been shown to decrease the risk of endometritis in patients who have labored or have ruptured membranes. Objective: The objective of this study was to assess the practical implementation of a protocol for vaginal cleansing prior to cesarean delivery and the subsequent effect on endometritis rates in a clinical setting. Study design: This is a before–after retrospective cohort study evaluating the first 6 months of implementation of a vaginal cleansing protocol at a single institution. The primary outcome was the rate of implementation. Secondary outcomes included endometritis and other postoperative complications. Results: The rate of implementation after 6 months was 68.3% ( p < .001) and postoperative endometritis rates decreased from 14.0% before implementation to 11.7% after implementation ( p .49, OR 0.77, CI 0.36–1.62). Postoperative fever decreased from 22.3% to 18.3% ( p .256, OR 0.70, CI 0.37–1.30) and infectious wound complications were 4.5% and 5.8%, respectively ( p .76, OR 1.07, CI 0.69–3.64). Conclusions: Implementation of a protocol for vaginal cleansing prior to cesarean delivery in women with ruptured membranes or in labor has high uptake, but in almost a third of eligible women it was not performed. The implementation, has led to a clinical, although not statistical, decrease in postoperative endometritis. Continued research is needed to explore how to improve uptake of this quality improvement measure.