Vaginal cleansing with povidone–iodine at cesarean section to reduce postpartum endometritis: A randomized controlled trial

Objective: To compare the incidence of post-caesarean endometritis in vaginal cleansing with povidone – iodine group versus control group.Methods: The present study was a prospective randomized controlled trial in which study subjects received a vaginal cleansing with povidone – iodine solution immediately prior to caesarean delivery while controls received no vaginal preparation. The primary outcome measured in the present study was incidence of postpartum endometritis. Secondary outcomes included wound infection, febrile illness and duration of hospital stay.Results: There was no significant difference in post-caesarean endometritis in the group that received the povidone–iodine vaginal preparation (n = 75) compared with the control group (n = 75) [1.3 vs. 6.6%; RR = 0.2; 95% CI = 0.02–1.67]. There were also no statistically significant differences in the incidence of febrile illness and wound infection between the experimental and control groups. However, subgroup analysis showed significant decrease in the incidence of postpartum endometritis in the group that received the povidone–iodine vaginal preparation (n = 20) compared with the control group (n = 13) [5% vs. 38.4%; RR = 0.13; 95% CI = 0.01–0.99]. Conclusion: Vaginal cleansing with povidone–iodine solution immediately prior to a caesarean delivery does not reduce the risk of post-operative endometritis. However, beneficial effect of reduction in the incidence of endometritis was seen in women who had premature rupture of membranes