The recommendation in this document thus supersedes the previous WHO recommendation on vaginal preparation with antiseptic agents for women undergoing caesarean section, as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections.
The primary audience for this recommendation includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to the prevention and treatment of peripartum infections) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and obstetricians, as well as managers of maternal and child health programmes, and relevant staff in ministries of health and training institutions, in all settings.
Summary of clarifying remarks:
- All women undergoing caesarean section should have vaginal cleansing with povidone-iodine (1% – 10%), for 30 seconds performed immediately before caesarean section (e.g. directly following preoperative urinary bladder catheterization to minimize the woman’s discomfort).
- While the evidence on vaginal preparation before caesarean section was largely derived from trials using povidone-iodine, benefit was demonstrated overall for any antiseptic (either povidone-iodine or chlorhexidine gluconate) versus no antiseptic. Included trials used varying concentrations of chlorhexidine gluconate (0.05% to 0.25%) or povidone-iodine (1% to 10%), and the base (aqueous or alcohol) was not described. Alcohol-based antiseptic solutions should not be used for vaginal preparation because of concerns around irritation of mucosa.
- This recommendation pertains to all women undergoing caesarean section regardless of their baseline risk of infectious morbidity following surgery (i.e. for caesarean section in women before or during labour, and women with intact or ruptured membranes).
- Vaginal preparation should be performed as close to the start of caesarean section as possible (e.g. directly following preoperative urinary bladder catheterization) to minimize the woman’s discomfort.
- The duration of vaginal preparation varied from 30 seconds to one minute. The Guideline Development Group noted that shorter application, i.e., 30 seconds, and contact time are likely to be associated with less maternal and fetal exposure, which is desirable.