Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.
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ABSTRACT:
SUBMITTER: Haas DM
PROVIDER: S-EPMC7195184 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
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Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.
Haas David M DM Morgan Sarah S Contreras Karenrose K Kimball Savannah S
The Cochrane database of systematic reviews 20200426
<h4>Background</h4>Cesarean 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. This is an update of a Cochrane Review first published in 2010 and subsequently updated in 2012 ...[more]
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Project description: Not available
| S-EPMC6513039 | biostudies-literature
Project description:ObjectiveTo 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.MethodsThis 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.ResultsA 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.ConclusionInstitutional policies for vaginal preparation before cesarean delivery were not associated with lower rates of surgical site infection in women undergoing cesarean delivery during labor.
| S-EPMC6059990 | biostudies-literature
Project description:This systematic review and meta-analysis was conducted to assess associations between changing gloves during cesarean section (CS) and postoperative infection. A literature search was conducted using the major electronic databases MEDLINE, Scopus, ISI Web of Science, PubMed, CINAHL, and CENTRAL from their inception to September 2020. Randomized controlled trials (RCTs) comparing glove change during CS to no glove change were included. Outcomes of interest were endometritis, febrile morbidity, and incisional surgical site infection (SSI). GRADE approach was applied to assess the quality of evidence. Ten reports of six studies involving 1707 participants were included in the analyses. Glove change was associated with a reduction in the risk of incisional SSI following CS (pooled RR 0.49, 95% CI 0.30, 0.78; moderate quality of evidence). Compared to no glove change, glove change during CS did not reduce the risks of endometritis (pooled RR 1.00, 95% CI 0.80, 1.24; low quality of evidence) or febrile morbidity (pooled RR 0.85, 95% CI 0.43, 1.71; very low quality of evidence). Changing gloves during CS was associated with a decreased risk of incisional SSI. The risks of postoperative endometritis and febrile morbidity were not altered by changing gloves.
| S-EPMC7907110 | biostudies-literature
Project description:BACKGROUND:The aim of this study was to evaluate the effect of vaginal repair in patients with cesarean section diverticulum (CSD) who had one or two previous cesarean sections (CSs). METHODS:From January 2012 to December 2014, 248 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital. These included 193 women with one previous cesarean section and 55 women with two previous cesarean sections. Excision and suture of CSD was performed through a vaginal approach. The duration of menstruation, the length, width and depth of the CSD and thickness of the remaining muscular layer (TRM) were evaluated before and after surgery by transvaginal three-dimensional (3D) color Doppler ultrasound. RESULTS:A total of 221 (89.11%) women were followed-up for more than 3?months, and 168 (67.74%) women were followed-up for more than 6?months. There were significant differences in the average duration of menstruation (7.77?±?2.05 and 8.02?±?2.06?days VS 13.99?±?3.71?days), the average size of CSD (5.54*9.19*5.60 and 5.75*9.04*6.18?mm VS 7.99*12.43*6.62?mm) and the TRM (7.61?±?2.52 and 7.60?±?3.00?mm VS 2.51?±?1.02?mm) after surgery compared with those figures before surgery. The results of this study reveal that vaginal repair could shorten the duration of menstruation and improve anatomical defects (P?<?0.05). Moreover, there was no significant difference in the effect of clinical repair between women with one or two previous cesarean sections (P?>?0.05). CONCLUSION:In CSD patients, the clinical effectiveness of vaginal repair was equivalent between women with one or two previous cesarean sections.
| S-EPMC7181476 | biostudies-literature
Project description: Not available
| S-EPMC6517158 | biostudies-literature
Project description: Not available
| S-EPMC7386833 | biostudies-literature
Project description:Cesarean section (CS) is recognized as being a shared environmental risk factor associated with chronic immune disease. A study of maternal gene expression changes between different delivery modes can add to our understanding of how CS contributes to disease patterns later in life. We evaluated the association of delivery mode with postpartum gene expression using a cross-sectional study of 324 mothers who delivered full-term (≥ 37 weeks) singletons. Of these, 181 mothers had a vaginal delivery and 143 had a CS delivery (60 with and 83 without labor). Antimicrobial peptides (AMP) were upregulated in vaginal delivery compared to CS with or without labor. Peptidase inhibitor 3 (PI3), a gene in the antimicrobial peptide pathway and known to be involved in antimicrobial and anti-inflammatory activities, showed a twofold increase in vaginal delivery compared to CS with or without labor (adjusted p-value 1.57 × 10-11 and 3.70 × 10-13, respectively). This study evaluates differences in gene expression by delivery mode and provides evidence of antimicrobial peptide upregulation in vaginal delivery compared to CS with or without labor. Further exploration is needed to determine if AMP upregulation provides protection against CS-associated diseases later in life.
| S-EPMC7576122 | biostudies-literature
Project description:BackgroundWith the development of China's two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC.Material and methodsThis observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.ResultsThe durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.ConclusionsLabor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.
| S-EPMC9308341 | biostudies-literature
Project description:IntroductionRates of delivery by cesarean section have gradually risen in many parts of the world, and it is regarded as a safe surgical procedure with expanded indications. We assessed maternal complications within 6 weeks postpartum after planned cesarean section and after planned vaginal delivery among patients without medical indication for cesarean section.Material and methodsThis was a retrospective cohort study based on Swedish national registers and included 714 326 deliveries from 2008 to 2017. The study group consisted of cephalic, singleton, term pregnancies and excluded those with previous cesarean or pregnancy conditions that would qualify for cesarean section. We compared the risks of short-term complications between planned cesarean section and planned vaginal delivery. We obtained adjusted risk ratios (ARRs) using modified Poisson regression models adjusting for maternal age, parity, body mass index, smoking, country of birth, and county.ResultsThe outcomes studied were infections and thromboembolism. In the planned cesarean section group (n = 22 855), 15% had a postpartum infection compared with 10% in the planned vaginal group (n = 691 471) (ARR 1.6; 95% confidence interval [CI] 1.5-1.6), and 0.08% vs 0.05% had a postpartum pulmonary embolism (ARR 1.7; 95% CI 1.0-2.6). The obtained risk estimates corresponded to "number needed to harm" estimates of 17 and 3448, respectively. When dividing the infections into subgroups, the risk of endometritis (ARR 1.2; 95% CI 1.1-1.3), wound infection (ARR 2.7; 95% CI 2.4-3.0), urinary tract infection (ARR 1.5; 95% CI 1.3-1.7), and mastitis (ARR 2.0; 1.9-2.2) was higher after planned cesarean section.ConclusionsAmong patients without medical indication for planned cesarean section, the risks of short-term maternal complications were higher with planned cesarean section than with planned vaginal delivery.
| S-EPMC9564441 | biostudies-literature
Project description:BackgroundThe emotional strains associated with impending cesarean sections pose significant challenges for primigravida women, potentially exacerbating anxiety levels and impacting overall well-being. Virtual reality (VR) technology has emerged as a nonpharmacological method for reducing preoperative anxiety.ObjectivesThis study aims to investigate the effectiveness of VR in reducing preoperative anxiety in primigravida women undergoing cesarean sections.DesignThis is a quasi-experimental study involving 38 first-time pregnant participants undergoing cesarean surgery.MethodIn this study, 38 first-time pregnant women undergoing cesarean surgery were divided into two groups: an intervention group (n = 19) and a control group (n = 19). The intervention group watched a VR video depicting various aspects of cesarean delivery, while the control group received no intervention and was instructed to consult their doctors or medical centers for information. Anxiety levels were assessed using the APAIS questionnaire before and after the intervention. Data analysis was performed using SPSS 25, including statistical tests like chi-square, Mann-Whitney, Wilcoxon, and logistic regression.ResultsThe intervention group experienced a significant reduction on average anxiety scores (11.63 ± 4.16) compared to the control group (14.78 ± 3.18) following the intervention. Within the intervention group, there was a statistically significant decrease in anxiety levels before and after the intervention (p < 0.05), indicating that the VR video intervention effectively reduced preoperative anxiety in pregnant women. Furthermore, there was a significant difference in anxiety levels between the control and intervention groups after the intervention (p = 0.02), whereas such a difference was not observed before the intervention (p = 0.21).ConclusionThis study demonstrates that VR technology is an effective and nonpharmacological method for reducing preoperative anxiety in primigravida women undergoing cesarean sections. The findings highlight the potential of VR interventions to improve patient well-being, offering an accessible, cost-effective solution for anxiety management in healthcare settings. These results underscore the transformative role of VR in enhancing the preoperative experience and supporting positive surgical outcomes.
| S-EPMC11893728 | biostudies-literature