Vaginal disinfection with chlorhexidine during childbirth

The purpose of this study was to determine whether chlorhexidine Vaginal do uching, applied by a squeeze bottle intra partum, reduced mother-to-child t ransmission of vaginal microorganisms including Streptococcus agalactiae (s treptococcus serogroup B = GBS) and hence infectious morbidity in both moth er and child. A prospective controlled study was conducted on pairs of moth ers and their offspring. During the first 4 months (reference phase), the v aginal flora of women in labour was recorded and the newborns monitored. Du ring the next 5 months (intervention phase), a trial of randomized, blinded placebo controlled douching with either 0.2% chlorhexidine or sterile sali ne was performed on 1130 women in vaginal labour. During childbirth, bacter ia were isolated from 78% of the women. Vertical transmission of microbes o ccurred in 43% of the reference deliveries. In the double blind study, vagi nal douching with chlorhexidine significantly reduced the vertical transmis sion race from 35% (saline) to 18% (chlorhexidine), (P < 0.000 1, 95% confi dence interval 0.12-0.22). The lower rate of bacteria isolated from the lat ter group was accompanied by a significantly reduced early infectious morbi dity in the neonates (P < 0.05, 95% confidence interval 0.00-0.06). This fi nding was particularly pronounced in Str. agalactiae infections (P < 0.0 1) . In the early postpartum period, fever in the mothers was significantly lo wer in the patients offered vaginal disinfection, a reduction from 7.2% in those douched using saline compared with 3.3% in those disinfected using ch lorhexidine (P < 0.05, 95% confidence interval 0.01-0.06). A parallel lower occurrence of urinary tract infections was also observed, 6.2% in the sali ne group as compared with 3.4% in the chlorhexidine group (P < 0.01, 95% co nfidence p interval 0.00-0.05). This prospective controlled trial demonstra ted that Vaginal douching with 0.2% chlorhexidine during labour can signifi cantly reduce both maternal and early neonatal infectious morbidity. The sq ueeze bottle procedure was simple, quick, and well tolerated. The beneficia l effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine. (C) 1999 Published by Elsevier S cience B.V. and International Society of Chemotherapy. All rights reserved.