Clinical Trial: Chlorhexidine Gluconate vs Povidone-Iodine Vaginal Cleansing Solution Prior to Cesarean Delivery

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Chlorhexidine Gluconate vs Povidone-Iodine Vaginal Cleansing Solution Prior to Cesarean Delivery: A Randomized Comparator Controlled Trial

Brief Summary: Endometritis, an infection of the uterus in the postpartum period, has been shown to complicate the postoperative course of a cesarean delivery in 6% to 27% of cases. Vaginal cleansing prior to cesarean delivery has been shown to minimize the presence of micro-organisms and risk of infection. Although povidone-iodine is the most commonly used anti-septic for surgical preparation of the vagina, it is not an ideal agent due to it's diminished efficacy in acidic vaginal pH and in the presence of blood. Chlorhexidine gluconate, on the other hand, has demonstrated superior disinfectant properties in several clinical trials, as compared to povidone iodine. In this randomized, comparator controlled, study the investigators will be comparing chlorhexidine gluconate vs povidone iodine for intrapartum vaginal preparation in women undergoing non-emergent cesarean delivery.

Detailed Summary:

This is a randomized, comparator controlled, study of intrapartum vaginal preparation with either chlorhexidine gluconate or povidone-iodine solution. Women undergoing non-emergent cesarean delivery will be randomized to receive vaginal cleansing with either 4% chlorhexidine solution or 10% providone-iodine solution.

The study will have two arms that will be randomized in a 1:1 ratio. After inclusion criteria have been satisfied, subjects in the comparator control arm will receive vaginal preparation with 10% provodone-iodine solution prior the skin incision. Subjects in the study arm will receive vaginal preparation with chlorohexidine gluconate 4% solution. The selected skin preparation will be applied according to the manufacture guidelines with a minimum of four completed minutes of drying time before placement of surgical drapes. A block randomization method will be used to control for variations in care. Both groups will receive standard obstetrical care, continuous fetal monitoring, and pre-operative prophylactic antibiotics at least one hour prior to skin incision.


Sponsor: Richmond University Medical Center

Current Primary Outcome: Postpartum endometritis [ Time Frame: 0-3 days postpartum ]

Clinical diagnosis, usually involving fever, uterine fundal tenderness, or purulent lochia requiring antibiotic therapy.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Postoperative wound infection [ Time Frame: 0-3 days post-partum ]
    Erythema, tenderness, purulent drainage from the incision site, with or without fever, requiring antibiotic therapy.
  • Postoperative fever [ Time Frame: 0-3 days post-partum ]
    Temperature greater than 38 degrees C or 100.4 degrees
  • Side effects [ Time Frame: 0-3 days post-partum ]
    Patient reported side effects of vaginal preparation (allergy, irritation)


Original Secondary Outcome: Same as current

Information By: Richmond University Medical Center

Dates:
Date Received: September 23, 2016
Date Started: December 2016
Date Completion: October 2017
Last Updated: December 14, 2016
Last Verified: December 2016