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Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV)

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Abstract

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Background

The incidence of chorioamnionitis occurs in between eight and 12 women for every 1000 live births and 96% of cases of chorioamnionitis are due to ascending infection. Following spontaneous vaginal delivery, 1% to 4% of women develop postpartum endometritis. The incidence of neonatal sepsis is 0.5% to 1% of all infants born. Maternal vaginal bacteria are the main agents for these infections. It is reasonable to speculate that prevention of maternal and neonatal infections might be possible by washing the vagina and cervix with an antibacterial agent for all women during labour. Chlorhexidine belongs to the class of compounds known as the bis‐biguanides. Chlorhexidine has antibacterial action against a wide range of aerobic and anaerobic bacteria, including those implicated in peripartal infections.

Objectives

To evaluate the effectiveness and side effects of chlorhexidine vaginal douching during labour in reducing maternal and neonatal infections (excluding group B streptococcal and HIV).

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 10), MEDLINE (from 1966 to 31 October 2010), LILACS (from 1982 to 31 October 2010) and reference lists. We also reviewed journal letters and editorials.

Selection criteria

Randomized or quasi‐randomized trials comparing chlorhexidine vaginal douching during labour with placebo or other vaginal disinfectant to prevent (reduce) maternal and neonatal infections (excluding group B streptococcal and HIV).

Data collection and analysis

Two review authors independently assessed trial eligibility and quality, extracted and interpreted the data. A third review author analyzed and interpreted the data. The fourth author also interpreted the data.

Main results

We included three studies (3012 participants). There was no evidence of an effect of vaginal chlorhexidine during labour in preventing maternal and neonatal infections. Although the data suggest a trend in reducing postpartum endometritis, the difference was not statistically significant (risk ratio 0.83; 95% confidence interval 0.61 to 1.13).

Authors' conclusions

There is no evidence to support the use of vaginal chlorhexidine during labour in preventing maternal and neonatal infections. There is a need for a well‐designed randomized controlled trial using appropriate concentration and volume of vaginal chlorhexidine irrigation solution and with adequate sample size.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding group B streptococcal and HIV)

Bacteria live in women's vaginas and generally cause no problems. Very occasionally they infect the placenta during labour and can pass to the baby, causing an infection. These infections can occasionally make the baby very ill and very occasionally the baby might die. The review of three trials (3012 participants) found there was not enough information to say whether the use of chlorhexidine washing of the vagina during labour led to fewer infections for mothers and babies. More research is needed.