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Institutional Protocols for Vaginal Preparation With Antiseptic Solution and Surgical Site Infection Rate in Women Undergoing Cesarean Delivery During Labor

La Rosa, Mauricio, MD; Jauk, Victoria, MPH; Saade, George, MD; Boggess, Kim, MD; Longo, Sherri, MD; Clark, Erin A. S., MD; Esplin, Sean, MD; Cleary, Kirsten, MD; Wapner, Ronald, MD; Letson, Kellett, MD; Owens, Michelle Y., MD; Blackwell, Sean, MD; Szychowski, Jeff M., PhD; Andrews, William W., MD, PhD; Tita, Alan T., MD, PhD for the Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium

doi: 10.1097/AOG.0000000000002745
Cesarean Delivery: Original Research: PDF Only

OBJECTIVE: To evaluate the association of institutional protocols for vaginal preparation with antiseptic solution and the surgical site infection rate in women undergoing cesarean delivery during labor.

METHODS: This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for cesarean delivery performed in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria. Maternal secondary outcomes included a composite of endometritis, wound infection or other infections, postoperative maternal fever, length of hospital stay, and the rates of hospital readmission, unexpected office visits, and emergency department visits.

RESULTS: A total of 523 women delivered in institutions with vaginal antisepsis policies before cesarean delivery and 1,490 delivered in institutions without such policies. There was no difference in superficial and deep surgical site infection rates between women with and without vaginal preparation (5.5% vs 4.1%; odds ratio [OR] 1.38, 95% CI 0.87–2.17), even after adjusting for possible confounders (adjusted OR 0.86, 95% CI 0.43–1.73). The lack of significant benefit was noted in all other maternal secondary outcomes.

CONCLUSION: Institutional policies for vaginal preparation before cesarean delivery were not associated with lower rates of surgical site infection in women undergoing cesarean delivery during labor.

Institutional protocols for vaginal preparation before cesarean delivery during labor do not decrease surgical site infection rates.

Department of Obstetrics and Gynecology, the University of Texas Medical Branch, Galveston, Texas; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the University of Alabama at Birmingham, Birmingham, Alabama; Oshner Health System, New Orleans, Louisiana; the University of Utah and Intermountain Health–LC, Salt Lake City, Utah; Columbia University, New York, New York; Mission Hospital, Asheville, North Carolina; the University of Mississippi at Jackson, Jackson, Mississippi, the University of Houston, Houston, Texas; and WakeMed Physician Practices, Raleigh, North Carolina.

Corresponding author: Mauricio La Rosa, MD, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587; email: malarosa@utmb.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received March 25, 2018

Received in revised form May 03, 2018

Accepted May 10, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.