Vaginal preparation with povidone iodine solution before caesarean section and its impact on the post-operative infectious morbidity

Background: A prospective randomized control trial (RCT) was conducted in the department of obstetrics and gynecology. The aim of the study was to evaluate the effect of pre-operative vaginal preparation with 1% povidone iodine solution on the post-operative caesarean infectious morbidity.Methods: 72 women were enrolled in the experimental group who received 1% povidone iodine vaginal wash and 72 in the control group who did not receive any vaginal wash. The investigators were blinded to the computer-generated random number table and to the allocation group. The clinical data was recorded and after its completion, the allocation group was revealed to the investigator. The data was tabulated and statistically analyzed using SPSS 21.Results: Age, parity, BMI, gestational age, blood loss, and operative time between the two groups was comparable. Pre-operative povidone iodine vaginal wash was more effective when membranes were intact versus ruptured. With intact membranes, statistical significance was reached for postoperative fever, seroma, endometritis, gaped incisional site, and foul discharge with p value 0.012, 0.012, 0.013, 0.027 and 0.012 respectively, between group A and B. The overall infectious morbidity in the 144 subjects showed statistical significance for endometritis, and foul-smelling lochia with p value 0.049 and 0.024 respectively; urinary tract infection, hospital stay duration, and incisional wound dehiscence were higher in group B versus group A, the difference in these parameters did not reach statistical significance.Conclusions: Pre-operative vaginal cleansing with 1% povidone iodine reduced post-operative infectious morbidity more effectively in those with intact membranes than ruptured membranes.