الفهرس 
POST-PARTUM INFECTIONSOnly 14 pages are availabe for public view
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Abstract
E
ndometritis and wound infection are common and significant postoperative morbidities with respect to patient cost, prolonged hospital stay, use of parenteral antibiotics, and patient discomfort. The risk of postcesarean infectious morbidity is reported to range from 5–85%, with the highest rate among indigent patients.
The most recognized risk factors for developing postcesarean endometritis involve pathways that introduce large quantities of bacteria into the uterine cavity. These include a large number of vaginal examinations in labor, prolonged duration of active labor, prolonged membrane rupture, and failure to use antimicrobial prophylaxis. Other reported risk factors include nulliparity, adolescence, the presence of intrapartum bacterial vaginosis, and the presence of an immunocompromised state such as diabetes mellitus or human immunodeficiency virus infection
The concept of vaginal antisepsis is not new to the field of gynecology. Since the 1970s, it has been demonstrated that a povidone-iodine vaginal scrub before vaginal surgery or abdominal hysterectomy is associated with lower postoperative infectious morbidity.
We conducted this prospective observative cohort study to asses the effect of vaginal preparation with antiseptic solution before cesarean section in reducing postpartum infections on pregnant women undergo caesarean section (emergency and elective) divided into two groups: group A received vaginal preparation with antiseptic solution povidone-iodine before cesarean section and group B not receive vaginal preparation before cesarean section. Primary outcome was Post-partum infection (endometritis and wound complications). And Secondary outcomes were Post-partum fever & Side effects of vaginal preparation (allergy, irritation).
Our results showed that
Endometritis was reported in more fifth of the studied cases. Wound infection was in about tenth of the studied cases. Postoperative fever was in more tenth of the studied cases.
In current study, endometritis, wound infection and postoperative fever were significantly less frequent in preparation subgroup. This means that, vaginal preparation was a significant protective factor from postoperative fever, wound infectionv& endometritis.
And wound infection, Postoperative fever and Endometritis significantly associated with each other.
CONCLUSION
V
aginal cleansing is a safe, rapid, cheap and well tolerated intervention, and should be used as an adjunct to prophylactic antibiotics immediately before caesarean section to reduce the bacterial exposure of the endometrium and other maternal tissues during caesarean section. Within our study population, this trial demonstrates a benefit of a preoperative vaginal scrub just before cesarean delivery. The incidence of postcesarean endometritis, fever and wound infection was significantly decreased in those subjects who were scrubbed with both abdominal andrecieved vaginal povidone-iodine compared with those who received a standard abdominal scrub alone.
Significant independent risk factors for endometritis, fever and wound infection were obesity and DM. so good antenatal care was helpufil for prevention of this comorbodites.
In conclusion, institutional policies of vaginal preparation prior to cesarean delivery was significantly associated with decreased the rate of infection comorbodites in women undergoing cesarean delivery.
RECOMMENDATIONS
1. Used in conjunction with prophylactic antibiotics, a vaginal povidone-iodine preparation may further decrease the number of bacteria species exposed to the endometrium at the time of uterine incision, especially Enterococcus species that are resistant to cefazolin prophylaxis. Further studies are required to confirm these findings before a change is practice is instituted
2. Given the increasing prevalence of obesity in women of childbearing age, makes identification of effective measures to improve wound healing and prevent infection after caesarean section is becoming increasingly urgent.