Effectiveness of preoperative vaginal preparation in reducing post-operative infection in patients who underwent emergency cesarean delivery: A systemic review and meta-analysis.

BACKGROUND

Emergency cesarean delivery (CD) is a risk factor for postpartum infection, but it is not clear whether preoperative vaginal disinfection can reduce the incidence of postoperative infectious diseases.

OBJECTIVE

This study evaluates the efficacy of preoperative vaginal preparation in patients undergoing emergency cesarean delivery.

METHOD: Seven predominant electronic databases were searched, including four English databases and three Chinese databases, from inception till April 30, 2024. Randomized trials that evaluated vaginal preparation before emergency CD were included in the study. All eligible studies were retrieved and subsequently managed using Note Express, RevMan, and R language. Discrepancies were resolved by group discussion. Outcomes such as postoperative endometritis, fever, wound infection, suspected neonatal sepsis, readmission, and emergency department visits were analyzed.

RESULTS

A total of 12 studies were identified in this study, involving 5055 participants, with 3002 patients in the experiment group and 2053 in the control group. In comparison with controls, the experiment group had a significant lower incidence of post-cesarean endometritis (RR = 0.49, 95% confidence interval [CI]: 0.29-0.82, P = 0.007) and a significantly lower incidence of suspected neonatal sepsis (RR = 0.46, 95% CI: 0.34-0.63, P < 0.01). Subgroup analysis showed a significantly lower incidence of endometritis as well as postoperative fever in experiment groups pertaining to both Asia and Africa.

CONCLUSION

Preoperative vaginal preparation prior to emergency cesarean delivery can reduce the occurrence of postoperative endometritis, fever, and suspected neonatal sepsis. Further larger multicenter randomized controlled trials should be conducted to confirm our results.