Vaginal preparation with povidone iodine and postcesarean infectious morbidity: A randomized controlled trial

Objective: To determine whether Vaginal preparation with povidone iodine be fore cesarean decreased the incidence of postpartum infectious morbidity. Methods: Participants were randomly assigned to vaginal preparation with po vidone iodine (n = 247) or no preparation (n = 251). Postpartum infectious morbidity included fever, defined as temperature of 38C or greater after th e day of surgery; endometritis, defined as fever with abdominal or uterine tenderness and initiation of intravenous antibiotics; and wound separation, defined as disruption of the abdominal incision that required wound care. We calculated overall rates of postpartum infectious morbidity, relative ri sks (RR), and 95% confidence intervals (CI) for the effect of vaginal prepa ration. As designed and reported, the trial had at least 80% power to detec t a 10% or greater absolute difference in rates of overall infectious morbi dity, fever, and endometritis (two-tailed, alpha = 0.05). Results: There was no difference between groups in maternal age, parity, ra ce, education, prior cesarean, type of anesthesia, labor before current ces arean, number of vaginal examinations during labor, internal monitoring, pr ophylactic antibiotic use, gestational age at delivery, or payment status. Excluding 68 women with chorioamnionitis, incidence of postoperative fever was 19.3%, endometritis 7.2%, and wound separation 7.0%. Vaginal preparatio n with povidone iodine before cesarean had no effect on risk for fever (RR 1.1, 95% CI 0.8, 1.6), endometritis (RR 1.6, 95% CI 0.8, 3.1), or wound sep aration (RR 0.6, 95% CI 0.3, 1.3). Conclusion: Vaginal preparation with povidone iodine before cesarean had no effect on the incidence of fever, endometritis, or wound infection. (C) 20 01 by The American College of Obstetricians and Gynecologists.