RANDOMIZED STUDY OF VAGINAL CHLORHEXIDINE DISINFECTION DURING LABOR TO PREVENT VERTICAL TRANSMISSION OF GROUP-B STREPTOCOCCI

Objective: To evaluate the effect of vaginal disinfection with chlorhe xidine gel during labor on vertical transmission of group B streptococ cus, as a method to prevent vertical transmission and subsequent neona tal early onset group B streptococcal disease. Study Design: A prospec tive study with randomization of 1020 parturients to one of three grou ps as soon as labor started, In all parturients, anus, introitus and c ervix were cultured semiquantitatively. Two groups were treated double -blindly with 10 mi of either a 0.3% chlorhexidine gel or a placebo ge l, applicated around the portio and into the fornices. If labor still continued, a second application was given after 10 h. The third group received no treatment. Ear, pharynx and umbilicus of all newborns were also cultured semiquantitatively. Results: Nine hundred and eighty on e women were evaluated. The overall incidence of group B streptococcal carriership was 19.4%. Vertical transmission was 52.4% in the chlorhe xidine group, 71.4% in the: placebo group and 66.7% in the control gro up (P = 0.069). When testing the transmission rates for the chlorhexid ine versus the combined placebo plus control group (69.3%), the differ ence was 16.9% (P = 0.026), Conclusion: Vaginal disinfection with a ch lorhexidine gel during labor modestly reduces group B streptococcal ve rtical transmission. Because the method is cheap, simple and safe, it should be considered for routine use. Our results indicate that it may reduce the incidence of early onset group B streptococcal sepsis by 2 -32%.