What is the result of vaginal cleansing with chlorhexidine during labour on maternal and neonatal infections? A systematic review of randomised trials with meta-analysis

Research output: Contribution to journalArticle

Authors

  • Charlotte Bell
  • Laura Hughes
  • Trevor Akister
  • Vin Ramkhelawon
  • Amie Wilson

Abstract

Background
Infection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity.

The objective of this systematic review is to review the effectiveness of intrapartum vaginal chlorhexidine in the reduction of maternal and neonatal colonisation and infectious morbidity.

Methods
Search strategy – Eight databases were searched for articles published in any language from inception to October 2016.

Selection criteria – Randomised controlled trials were included.

Data Collection and analysis - Publications were assessed for inclusion. Data were extracted and assessed for risk of bias.

Relative risks from individual studies were pooled using a random effects model and the heterogeneity of treatment was evaluated using Chi2 and I2 tests.

Results
Eleven randomised controlled trials (n = 20,101) evaluated intrapartum vaginal chlorhexidine interventions. Meta-analysis found no significant differences between the intervention and control groups for any of the four outcomes: maternal or neonatal colonization or infection. The preferred method for chlorhexidine administration was vaginal irrigation.

Conclusions
Meta-analysis did not demonstrate improved maternal or neonatal outcomes with intrapartum vaginal chlorhexidine cleansing, however this may be due to the limitations of the available studies. A larger, multicentre randomised controlled trial, powered to accurately evaluate the effect of intrapartum vaginal chlorhexidine cleansing on neonatal outcomes may still be informative; the technique of douching may be the most promising.

Details

Original languageEnglish
Article number139
JournalBMC pregnancy and childbirth
Volume18
Publication statusPublished - 8 May 2018