الفهرس 
EndometritisOnly 14 pages are availabe for public view
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Abstract
C
esarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman’s return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries.
Endometritis, an infection of the uterus in the postpartum period, can complicate the postoperative course of a cesarean delivery 6% to 27% of the time, This complication, up to 10 times more frequent after a cesarean delivery than after vaginal delivery, can lead to serious complications of bacterial infection in the blood (10%to 20%), peritonitis, intra-abdominal abscess and sepsis.
Additionally, cesarean deliveries are frequently complicated by maternal fever and wound complications including seroma, hematoma, infection, and separation. These morbidities can lead to significant delay in a return to normal function.
Post-cesarean endometritis and infectious morbidity are the result often of the presence of bacteria in the vagina and cervix that move higher in the genital tract to infect the uterus. These bacteria have been shown to be responsible for failure of antibiotic prophylaxis during cesarean deliveries.
Systematic review of randomized and quasi-randomized trials _on Cochrane data base Dec 2014_ assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity concluded that Vaginal preparation with povidone-iodine solution immediately before cesarean delivery reduces the risk of postoperative endometritis. This benefit is particularly realized for women undergoing cesarean delivery, who are already in labor or who have ruptured membranes.
Chlorhexidine is an ulternative antiseptic solution used for surgical site & IV catheter site preparation with higher efficacy than povidone iodine & also used for vaginal wash during labour skin antisepsis in neonates to prevent neonatal sepsis with high efficacy. Chlorohexidine was compared to povidone iodine in preoperative vaginal preparation before hysterectomy & was found to be more effective in decreasing bacterial colonization in vagina.
This is a two armed RCT comparing the efficacy of preoperative vaginal preparation with povidone iodine versus chlorohexidine in preventing postoperative endometritis, in which patients are randomly allocated in two groups first group will be subjected to immediate preoperative vaginal preparation with povidone Iodine while The second group will be subjected to immediate preoperative vaginal preparation with Chorhexidine 2%.
Research hypothesis was that vaginal preparation with chlorhexidine solution immediately before cesarean section is superior to that with povidone iodine as regard decreasing rate of postoperative endometritis.
Patients were followed up till the end of perperium for symptoms & signs of endometritis (fever above 38°C, infected lochia & lower abdominal tenderness).
Risk analysis for the incidence of endometritis was done by calculation of the relative risk and odds ratio for the event of interest using the povidone iodine group as the reference group.
Relative risk of postoperative endometritis in chlorohexidine group to povidone iodine group= 0.5 with 95% CI from 0.16 to 1.55, which means insignificant results supporting the null hypothesis.