Original Article Egyptian Journal of Health Care, 2021 EJH vol. 12 no.

Effect of Vaginal Cleansing with Povidone Iodine Solution before

Cesarean Section on Postoperative Endometritis Infection

Safaa Soliman Ahmed Mohamed¹ Ashraf Samir Faheem² Hanan Fawzy Elsayed Ali³
¹ Maternal and Newborn Health Nursing Beni-sueif University
² Obstetrics and gynecology Faculty of Medicine - Beni suef university
³ Maternal and Newborn Health Nursing Helwan University

Abstract

Background: Cesarean section (CS) continues to be the surgical intervention most often
performed in obstetrics, with a daily increasing frequency of use. The risk for all postpartum
infections is increased in CS compared to vaginal delivery. Infectious complications developing
in the aftermath of CS are one of the main causes of maternal morbidity. So, the aim of this study
was to investigate the effect of vaginal cleansing with Povidone Iodine solution before cesarean
section on postoperative Endometritis Infection . Design: A quasi- experimental design was
utilized in this study. Setting: This study was conducted at the operating room of Obstetrics and
Gynecologic Department in Beni-Seuf University Hospital from the period of May 2019 until
August 2019. The study Subjects included 200 pregnant women undergoing elective cesarean
delivery, who were selected by purposive sampling technique. then divided into control and study
group 100 per each group. The study group receive vaginal cleansing before cesarean section by
antiseptic iodine solution 10% and standard abdominal scrub. Control group receive standard
abdominal scrub only. Tools was used of data collection included; 1st tool: Structured interview
questionnaire was designed by the researchers and included demographic characteristics and data
related to the participants’ clinical profile 2nd tool: Postpartum follow-up checklist to assess
presence or absence of the post CS infectious morbidity such as; endometritis (lower abdomen
pain and a smelly vaginal discharge), febrile morbidity, and incisional site infection.3rd tool:
Numericаl rating scale (NRЅ). Study results: Shows there was statistically significant
difference regards fever and a smelly vaginal discharge among both groups, while there was no
statistically significant difference was found regards wound infection and lower abdomen pain.
Conclusion: Preoperative vaginal cleansing using antiseptic iodine solution 10% was an effective
practice for reducing post cesarean endometritis where overall post cesarean infectious morbidity
rate was lower among study group compared to control those exposed to routine care alone;
supporting the study hypothesis. Recommendations: Physicians and Nurses should be used
antiseptic povidone-Iodine 10% or vaginal cleaning as regular practice before cesarean deliveries.
Apply vaginal preparation with anti septic solution before C.S operation for high risk group for
infection as premature rupture of membranes, diabetes, and anemia.
Key words: Efficacy, Vaginal Cleansing, Cesarean Delivery, Antiseptic A Povidone Iodine
Solution, Postoperative Endometritis Infection
Email: safa.ashraf @yahoo.com
Introduction has considered the ideal incidence for CS
to be between 10% and
The most prevalent significant pro 15%. Approximately 25% of pregnant fe
cedure is delivery of the worldwide caesa males in the UK undergo CS for their chil
rean section (CS), For recently 30 years, dren to be delivered. In England alone, thi
the international healthcare community s is equivalent to about 171,000 caesarean
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sections per year(Morton et as to prepare a povidone iodine solution;

al.,2018).Cesarean section deliveries povidone iodine gained by complexation
represent a large percentage of all births of povidone and iodine has good stability,
worldwide (Boyle and Reddy,2013) for meets the necessities of the medical
example, in the US, cesarean delivery disinfection industry on povidone iodine,
accounts 30% of all births and procedure and solves the problem of poor stability
is the most common method of major of povidone iodine. At the same time,
female surgery (MaDorman et al., 2018). povidone iodine prepared by water
Caesarean section rates in Egypt is solution method is more appropriate for
22percent, with higher rates in private usage (Haynes et al., 2019).
hospitals (Mohamed et al., 2015)
Risk factors for endometries
Sepsis and post-natal infection following CS include in the caesarean
have a significant impact on maternal section labour and ruptured membranes
mortality and morbidity, as well as on with or without vaginal colonization with
post-natal healing and maternal wellbeing. group B streptococcus(Morton et
there are several primary sources of al.,2018) and the frequency of post
infection after CS including endometritis. cesarean section infection ranges from 7-
For women with Caesarean range 5-20 20% depending on operating time,
times more vulnerable to infection than maternal body mass index, length of labor,
women with normal delivery of the number of vaginal exams during labor,
vagina . After cesarean delivery, blood loss amount, emergency or elective
infectious complications are a major caesarean delivery and surgeon
cause of maternal morbidity and may experience (Mohamed,2013& Mohamed
extend the hospitalstay. These include et al., 2015).
fever,swollen wounds and after pregency
inflammation of the uterus lining (Haas Post cesarean wound infection and
et al., &Mohamed, 2014). Endometritis endometritis continue to be a severe
is the commonest complication as it morbidity, in spite of use of strategies to
records up to 27%, followed by clinically avoid these complications in terms of
significant fever, which was reported as patient pain, patient cost, antibiotic use
5–24%, while the occurrence of wound and extended hospital stay. The risk of
infection is about 2–9% (Magdy et al., post cesarean infectious morbidity varies
2017). from 5-85 percent. Pathways are the most
known risk factors for post cesarean
The invention reveals a povidone endometries (Mohamed et al., 2015).
iodine, which includes the following Preoperative vaginal washing by
components: 10.0%-50.0% of polyvinyl povidone-iodine before hysterectomy and
pyrrolidone k30, 2.34%-11.44% of iodine, CS reduces the occurrence of
1.17-5.72% of potassium iodide, 5.0- postoperative infectious morbidity (Haas,
45.0% of a solvent n-propanol, 0.01%- 2012). Also (Ameer, 2019) showed that
10.0% of a stability auxiliary agent and preoperative vaginal cleansing with
the balance of water. The creation also povidone -iodine decreases the
discloses a preparation method of occurrence of post-cesarean endometritis.
povidone iodine. The preparation method
of povidone iodine delivered by the Significant of the study:
invention employs a solution method for
complex of polyvinyl lpyrrolidone, iodine Among developing countries, the
and additives under certain conditions, so rate of puerperal infection remains the
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most common cause of morbidity and

mortality. CS is the most important factor
in the risk of puerperal infection with an Aim of the study:
estimated 5-20-fold rise in incidence
(Mohamed et al., 2015). After CS To investigate effect of vaginal
(infectious morbidity is a significant cleansing with povidone iodine solution
problem that affects woman health and before cesarean delivery on postoperative
represents an economic burden. Usually endometritis infection
post CS infectious morbidity seems in
form of endometritis in 6% to 27%, Research hypothesis: The women
febrile morbidity in 5% to 24%, and who are undergoing vaginal cleansing by
infection at the incisional site which using antiseptic a povidone iodine
happens in around 2% to 9% of post solution prior to cesarean delivery will
cesarean deliveries. Endometritis occurs have less postoperative endometritis
10 times post cesarean deliveries infection.
compared to vaginal births, It can be
progressed to source of pelvic abscess,
Materials and Method
peritonitis, or even septicemia; which is
of a great concern deliveries (Marzouket
Research design: Quasi-
al.,2019). Pelvic abscess, peritonitis, or
experimental design (randomized
even septicemia after cesarean delivery
controlled trials)was utilized in this study
can have a tremendous impact on the
postpartum woman's return to normal
Research Setting : This study was
function and her ability to care for her
conducted at the operating room of
baby. It can also cause health problems
Obstetrics and Gynecologic Department
and sequelae that are deserving. Finding
in Beni-Seuf University Hospital from the
an easy and inexpensive way to reduce
period of May 2019 until August 2019.
this risk could have a major impact on
both developed and developing countries '
public health. There is a good evidence in Subjects of the study A
the literature that preoperative vaginal convenience sample of 490 pregnant
sterilization with povidone – iodine is womens undergoing elective cesarean
effective before Cs labor in decreasing delivery were recruited in the study.
the occurrence of postoperative infectious
morbidity. Current data on the impact of Inclusion criteria:-
such a measure on post-care infectious
morbidity is unclear, however, as some 1. Full term pregnant women.
studies have shown no significant
effect(Aref ,2019).While other studies 2. Elective cesarean delivery
have reported a significant reduction in
post-cesarean infections with the use of 3. Age ranged between 20 -35
povidone-iodine solution(Reid, years.
Hartmann ,McMahon, Fry (2001)
&Yildirim etal.,2012), this has Exclusion criteria:-
encouraged us to investigate the
effectiveness of povidone-iodine vaginal 1.Women who are at risk for
preparation by 10 percent at post-CS developing postpartum infection as
infectious morbidity levels and to suggest premature rupture of membranes, diabetes
its daily use if it is found to be effective. mellitus, anemia and immune
compromised status.
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2.History of post cesarean section duration of wash before CS, method of

infection, obstructed labor, or wash and washing places)
preeclampsia
II. Postpartum follow-up
3.Women whose given history of checklist: It developed by the researcher
being allergic to antiseptic iodine solution. to record the It was developed by the
researchers and completed at the first
-The sample size was calculated postpartum follow-up visit (i.e., at the 10th
using the following formula postpartum day). It was aimed to assess
Yamane ,(1967). presence or absence of the post CS
infectious morbidity: endometritis, febrile
n= N morbidity, and incisional site infection. as
1+N (e) 2 ( fever, wound infection, lower abdomen
pain and vaginal discharge).
Where: n= sample size, N =
patients (490), e = margin error (0.05). -Endometritis was evident as
“Postoperative fever of 38.4_C or more,
Sample size=220 pregnant women connected with uterine tenderness and
offensive smelling lochia requiring
The sample size was (220) intravenous antibiotic treatment”.
pregnant women. The researchers
excluded 20 pregnant women of a pilot -Postoperative fever was detected
study from the sample. The subjects were by “Oral temperature of 38_C or more
divided into two groups: Group (A): after first day of surgery; in absence of
study group: consisted of 100 pregnant clinical causes of infection such as breast
women who receiving vaginal cleansing engorgement or urinary tract infection”.
prior to cesarean section by antiseptic a
povidone iodine solution 10%and - Wound infection was known by
standard abdominal scrub. Group (B): occurrence of erythema or occurrence of
Control group: consisted of 100 pregnant abdominal incision disruption, with
women who receiving standard purulent discharge from incision site that
abdominal scrub only. requires antibiotics and wound care.

Tools of Data Collection: Numericаl rating scаle (NRЅ)

Data were collected by three tools It meаns (verbаl rating scаle

as the following: (VRЅ); visuаl analogue scale. VAЅ for
studied groups; adopted from
I. Structured interview Hockenberry & Wilson, (2015) and
questionnaire; which headed into two Ѕong et аl., (2016); it was used to assess
sections perence of pаin. It consisted of а line
divided by numbered points ranged from
Part I: Participants’ Obstetric data: (0-10) consisting of six cartoon faces that
to assess (age, para, gravid, weight, range from a neutral expression (0 no
Gestational age at delivery, Preoperative pаin) to a screaming face (10 hurts more
Hb and Postoperative hospital stay). than).

Part II: Participants’ clinical

profile: to assess (C.S type and time,

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Research process

Validity of the study: Tools used Field work

in the study were developed by the
researchers after reviewing of the current - Collection of data covered a
local and international related literatures period of 4 months from beginning of
using books, articles and scientific May 2019 until end of August 2019. The
magazines. This helped them to be researcher attained predetermine setting 3
acquainted with the problem, and guided days per week(Saturday, Monday, and
them in the process of tools' designing. Wednesday) from 9 am to 2 pm..
Tools was reviewed by jury of 3
expertise's in the field of the study to test - The study and control group
its contents and face validly. were assigned; where the odd numbers
were recruited as study group and the
A permission letter was issued even numbers are recruited as control
from the Dean of Beni-Suef Faculty of group.
Nursing to the directors of the research
settings. The researcher obtained official - Women were assessed and their
approval from the administrators of the medical records were reviewed according
study settings to carry out the study. A to inclusion and exclusion criteria,
clear explanation was given about the aim, maternal demographic details were
nature, importance, and expected recorded along with the indication of
outcomes of the study. caesarean section, the suitable cases were
asked to give written consent for
A Pilot study A pilot study was participation in study.
conducted on 20(10%) woman from the a
aforementioned setting to measure the The present clinical experimental
feasibility of the study setting , content was accomplished by passing through
validity of the tools and time required for three phases: Initial phase,
the completion of each tool. Results implementation phase, and evaluation of
obtained were useful in appraisal and the studied women outcomes phase.
modification of the tools; these subjects
were later excluded from the study (1) Initial phase
sample.
At waiting area of operating room,
Ethical consideration is respected. each pregnant woman allocated for
Oral consent was obtained from each elective CS was interviewed. Aim and
study participant after explanation of the nature of the study were explained and
study aim and benefit in each study informed written consents were signed
setting. The study subjects were from the eligible pregnant mothers. At the
interviewed individually and reassured same phase, the group’s allocation was
that all data would be confidential and recognized.
used only for research purpose.
Participants were also told of their right to (2) Implementation phase
withdraw from the study without
providing any reason at any time. In this phase, subjects of the
control group were received the

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traditional preoperative care, while pregnant women who receiving vaginal

subjects of the study group were cleansing prior to cesarean section by
subjected to preoperative vaginal antiseptic a povidone iodine solution
cleansing using antiseptic a povidone 10%immediately 30s.before skin incision
iodine solution 10%; in addition to the by sponge sticks and Group (B): 50 of
traditional care. them receiving vaginal cleansing
immediately 60s.before skin incision by
a. The traditional preoperative douches with standard abdominal scrub.
care The vaginal cleansing was done by
preparing a sterile bowl with 20 ml
The traditional preoperative care povidone-iodine10% solution.
involves the abdominal skin scrub, which
was done according to the following steps: - The reseachers Exclued the
mothers who suffering from fever due to
1) prepare sterile bowel with 30 ml any others problems for example (mastitis,
povidone-iodine10%, 2) after breast engorgement and phlebitis) from
anesthetizing the studied pregnant woman the studied sample during follow up.
and inserting the Foley’s catheter,
abdominal scrub was done by the (3) The evaluation phase
scrubbed surgeon in form of strong rub of
the abdominal incision area using The study follow up (i.e.,
endometritis, fever, abdominal pain and
sterile gauze soaked in povidone- surgical site infection) were evaluated at
iodine 10% solution. It was continued the 10th day postpartum; where the
around one to two minutes; to ensure free adhesive tape covering the incision
of dirt, sweat, and skin microorganisms, detached and the incision site was
and 3) the disinfected skin area was exposed for assessment.
rubbed with another sterile gauze.
Prophylactic intravenous antibiotic was Statistical Analysis Statistical
given immediately before skin incision. It Package for Social Sciences (SPSS)
is usually 1 gram Cefotaxime. Thereafter, version 17.0 was used for quantitative
the cesarean section operation was started data analysis. Quality control was done at
as lower part incision without any the stages of coding and data entry. Data
intervention over the traditional care. were presented using descriptive statistics
in the form of frequencies and
b. Care of the study group percentages for qualitative variables, and
means and standard deviations for
Subjects of the study group were quantitative variables. Qualitative
received the traditional care in addition to variables were compared using T test and
vaginal cleansing with povidone- Correlation (r) test. Cronbach's α (alpha)
iodine10% solution. After anesthetizing is used for test score reliability measure
the studied pregnant woman and inserting of sample Statistical significance was
the Foley’s catheter, vaginal cleansing considered at p-value <0.05, highly
was done by the scrubbed nurse significant difference obtained at P < 0.0l
researcher; who was aware about group and non significant difference obtained at
allocation and did not involve in P > 0.05.
incisional site assessment. The researcher
divided the studied woman into two Results
groups: Group (A): consisted of 50

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Table (1) presents data related to Table (3) shows no statistically

general and anthropometric measure significant difference between both
between intervention and control groups, groups regarding to cesarean section time.
there was no statistically significant
difference between both groups regarding Fig 1 shows that duration of
to maternal age, gravid and Para p value > hospital stay ranged from one to two days.
0.05. While there was highly statistically About 92% of mother in intervention
significant difference between both group stay one day compare to 88% in
groups regarding to maternal weight p = control group .There was no statistically
0.001 significant difference between both
groups regarding hospital stay.
Regarding to types and causes of
cesarean section: Table (2) shows (41%) Table (4) shows that there was
of intervention group had primary CS statistically significant difference regards
compare to (45%) of control group and fever and a smelly vaginal discharge
(59%) of intervention group had among both groups. While there was no
secondary Cs compare to 55% of control statistically significant difference found
group there no statistically significant regards wound infection and Lower
difference was found. Also this table abdomen pain among both groups.
shows that the most common cause of CS
is previous Cs (40%) of intervention Table (5) shows that there was
group compare to(45%) of control group highly statistically significant difference
and(27%) of intervention group had regards fever, wound infection, pain and
malpresentation and position compare to vaginal discharge among studied group in
(25%) of control group. There no duration of wash before CS and method
statistically significant difference was of wash.
found between both groups

Table (1): General Data and anthropometric Measure between Intervention and
Control Groups:

Variable Control group (100) Study Group (100) T test P value

Age Mean± SD 28.230±4.564 29.210±4.546 0.04 >0.05

Gravid Mean± SD 1.560±0.761 1.570±0.724 0.2 >0.05

Para Mean± SD 1.340±0.522 1.360±.545 0.5 >0.05

Weight Mean± SD 83.210±9.710 79.230±10.680 2.7 >0.05

Gestational age at 38.5 ± 1.7 38.3 ±1.4 2.17 >0.05

delivery (weeks)
Mean± SD
Preoperative Hb 10.8±1.4 10.9 ±1.6 0.08 >0.05
(gm/dl)
Mean± SD
Postoperative hospital 3.4±1.2 2.8±1.4 14 >0.05
stay (days)
Mean± SD

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Table (2): Comparison between Both Groups as Regards Types and Causes of
Cesarean Section

Control group (100) Study Group (100) X P

Variable NO % NO % value
C.S Type
Primary 45 45.0 41 41.0
Secondary 55 55.0 59 59.0 2.96 >0.05
Causes of CS
Previous cs 45 45.0 40 40.0
Malpresentation or position 25 25.0 27 27 .0 2.8 >0.05
Maternal distress 12 12.0 8 8.0
Fetal distress 7 7.0 10 10.0
Premature rupture of membranes 5 5.0 7 7 .0
Suspected Macrosomic 6 6.0 8 8.0

Table (3): Comparison between both Groups as Regards Cesarean Section Time,
Duration of wash, Method of wash and Washing places

Variable Control group Study Group T test P value

(100) (100)
Cs Time
Mean± SD. 40.160±12.515 41.580±14.714 t=0.74 >0.05

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Fig (1): Comparison between both groups as regards hospital stay

Table (4):Comparison between both Groups as Regards Post operative Fever,

Wound Infection, pain and vaginal discharge.

Variable Control group (85) Study Group (92) X P value

NO % NO %
Fever 23 27.1 13 14.1 6.1 0.001
Wound infection 11 12.9 5 5.4 1.23 >0.05
A smelly vaginal 12 14.1 6 6.5 4.86 0.001
discharge
Lower abdomen pain 10 11.7 5 5.4 1.11 >0.05

Table (5): Comparison between Duration of Wash before CS and Method of Was
has Regards Post Operative Fever , Wound Infection, Pain and Vaginal Discharge for
Studied Group.

Variable Study Group P value

Method of wash and Duration of wash before CS

Sponge stick for 30s(n=50) Douche for 60s (n=50)

Fever 2.1 12.0 < 0. 01

Wound infection 0.0 5.4 < 0. 01
A smelly vaginal 1.0 5.5 < 0. 01
discharge
Lower abdomen pain 1.0 4.3 < 0. 01
Discussion Postpartum morbidities such as
wound infection and endometritis also
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complicate the operation of the cesarean supported the study hypotheses that the
section. Such morbidities cause pain and women who are undergoing vaginal
discomfort, delay in returning to normal preparation with antiseptic solution
function. The endometritis cause is (povidone-iodine ) before cesarean
frequently ascending of the upper genital section will have less post partum
tract by cervicovaginal flora. During morbidity. The results of the present
cesarean deliveries, these bacteria are study showed that general data of the
responsible for antibiotic prophylaxis study subjects as age, gravid and para
failure. Furthermore, some prophylactic were not show any significant difference
antibiotic regimens are not effective and between control and study group. This
after surgical prophylaxis, the vagina may insignificant difference between the
colonize with resistant organisms. general and obstetric characteristics data
(Mohamed et al., 2015). The issue of of both groups are reported by many
using preoperative vaginal washing is not studies Hayat et al (2014), Mohamed et
recent and it was previously used since al., (2015).
the early seventies prior to CS, abdominal
hysterectomy and was proved to be Concerning to Postoperative fever
associated with lower postoperative and a smelly vaginal discharge study
infectious morbidity, as well as, findings shown that there was statistical
documented decreasing in the bacteria significant difference between study and
count in vagina by at least 98% with control group. These findings were in
povidone iodine solution (Madny & agreement with Hayat et al (2014) who
Ahmed.,2011). study the effect of vaginal cleaning before
cesarean delivery to reduce post cesarean
There are different methods, to section &postpartum infection and
decrease the risk of infection. These founded that there was statistically
include preoperative antiseptic vaginal significant increase in temperature of
douching on the morning of surgery, control group in comparison to study
wipes, sponges, etc. with any type of group and stated that Vaginal cleansing
antiseptic solution (povidone iodine, with povidone iodine solution reduces the
chlorhexidine, etc). The intervention of risk of post-cesarean endometritis from
vaginal cleansing is a safe and very 8.3% in control groups to 4.3% in vaginal
quickly perfect procedure that can easily cleansing groups. ore over (Tewfik, et al.,
be done before abdominal scrub (Hass et 2015) who study Preoperative vaginal
al., 2014). At the present time, there is no preparation using povidone iodine versus
clear recommendation for or against chlorhexidine solutions in prevention of
vaginal cleansing before cesarean endometritis in elective cesarean section
delivery. So, The aim of this study was to and mentioned that,there was a
investigate the efficacy of vaginal significantly higher rate of postoperative
cleansing before cesarean delivery in fever in group A (Povidone Iodine)
reducing postoperative morbidity. compared to group B (Chlorhexidine
group) (13 (28.3%) versus 4 (8.5%);
The results of the study showed respectively), while the rates of
that using antiseptic povidone-iodine endometritis and wound infection were
solution for cleaning of the vagina before higher in group A (Povidone Iodine)
cesarean section operation decreased the compared to group B (Chlorhexidine
occurrence of postpartum morbidity as group), but this difference was
fever, wound infection, lower abdomen statistically insignificant therefore this
pain and vaginal discharge. This findings result in the same line of current study

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findings that has been mentioned, there with Haiyan et al (2020) who study
was no statistically significant difference Optimization of Cleaning Management
found regards wound infection and Lower Improves the Efficiency of the
abdomen pain among both groups. Also Continuous Surgery and reported that
study results in the same line with Ried et scientific cleaning management can
al (2001) who study effect of vaginal significantly improve the efficiency of the
preparation on post cesarean infectious operation, prevent the spread of bacteria
morbidity and stated that 7.2% of samples in the operating room, improve the
under study had oral temperature elevated efficiency of the operating room, and
to 37.7 of or more than after the day of thereby increase surgeon and patient
surgery. satisfaction. Additionally Marzouk,
Emarah & Zaitoun,(2019) who
While study results were in reported that assessment of the
disagreement with Ameer., (2019) who incisional wound revealed lower overall
evaluate the risk of post cesarean post cesarean section infectious morbidity
endometritis with preoperative vaginal rate among study group compared to
preparation and reported that there was no those received conventional care (9.0% vs.
measurable effect of a vaginal scrub on 20.2% respectively; 2 = 4.50, p = .034).
the development of postoperative fever. Endometritis rate was significantly lower
Additionally Tewfik, Ibrahim, Hanafi, among the study group subjects equated
Fahmy, Khaled & Ibrahim., (2015) who to those of the conventional care group
study Preoperative vaginal preparation (2.2% vs. 10.1% respectively; _2 = 4.75,
using povidone iodine versus p = .029), meanwhile febrile morbidity
chlorhexidine solutions in prevention of and surgical site infection rates showed
endometritis in elective cesarean section non-significant reduction in favor to the
and indicated that, use of chlorhexidine study group subjects (p = .469 and .700
rather than povidone iodine was respectively). This findings supported the
significantly associated with 3-fold study hypotheses that the women who are
reduction in the risk of post-operative undergoing vaginal preparation with
fever. antiseptic solution (povidone-iodine )
before cesarean section will have less
In relation to fever, wound post partum morbidity infection.
infection, lower abdomen pain and a
smelly vaginal discharge study findings In relation to fever, wound
revealed that the rate of fever, wound infection, lower abdomen pain and a
infection, lower abdomen pain and smelly vaginal discharge study results
vaginal discharge were lower in the study shown that the rate of fever, wound
group than control group and the infection, lower abdomen pain and
difference is not statistically significant in vaginal discharge were lower in between
wound infection and lower abdomen pain the studied group by using sponge stick
while the difference is highly statistically for 30 s. and there was highly statistically
significant in fever and vaginal discharge significant difference regards fever ,
therefore according to the reseachers` wound infection, pain and vaginal
opinion that, the povidone-iodine solution discharge among studied group in
has a significant role in prevent or reduce duration of wash before CS and method
post partum morbidity such as (fever, of wash. These study results were in
wound infection, lower abdomen pain and agreement with Caissutti et al (2017)
a smelly vaginal discharge ) after Cs. who study Vaginal Cleansing Before
These study results were in agreement Cesarean Delivery A Systematic Review

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Original Article Egyptian Journal of Health Care, 2021 EJH vol. 12 no. 2

and Meta-analysis and reported that o Physicians and Nurses should be

Vaginal cleansing immediately before used antiseptic povidone-iodine 10% or
cesarean delivery in women in labor and vaginal cleaning as regular practice
in women with ruptured membranes before cesarean deliveries.
reduces the risk of postoperative
endometritis and recommend preoperative o Apply vaginal preparation with
vaginal preparation before cesarean anti septic solution before C.S operation
delivery in these women with sponge for high risk group for infection as
stick preparation of povidone– iodine premature rupture of membranes, diabetes,
10% for at least 30 seconds . This anemia.
findings supported the study hypotheses
that the women who are undergoing
vaginal preparation with antiseptic
solution (povidone-iodine ) before Conflict of interest
cesarean section will have less post
partum morbidity infection. So according
There were no conflicts of interest.
to the researchers'` opinion that, the
povidone-iodine solution, duration of
Funding
wash and method has a significant role in
prevent or reduce post partum morbidity
infection such as (fever, wound infection, The author(s) received no financial
lower abdomen pain and a smelly vaginal support for the research, authorship,
discharge ) after Cs. and/or publication of this article

Interpretation of the study findings References

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