Rates of infection after vaginal preparation for cesarean section in the quotidian setting

Surgical site infections (SSI), especially endometritis, are a major source of morbidity and mortality for women who undergo cesarean section. These infections lead to slower recovery, interfere with mother-baby bonding, and increase length of hospital stay. Preoperative and perioperative measures to prevent these infections have been studied, with one including the use of vaginal preparation prior to c-section. Multiple randomized control studies have shown that the use of vaginal preparation prior to c-section decreases the rate of SSI. Although these RCTs have been able to show a reduction of about 50%, real-world clinical implementations of this protocol and results are lacking. The objective of this study was to determine if results from RCTs of vaginal preparation can be replicated in a real-world setting. We performed a retrospective cohort study on women undergoing c-section at The University of Maryland Medical Center before and after the implementation of a vaginal preparation policy. The rates of all surgical site infections and endometritis were assessed and compared between the two groups. A total of 929 patients were enrolled, and after accounting for exclusion criteria, a total of 797 patients were included in the analysis. We found that implementation of vaginal preparation policy was associated with a statistically significant decrease in the rate of endometritis (n(4.9%) v n(2%), p =0.023) and all surgical site infections(n(5.6%) v n(2%), p =0.006) (table1). A similar reduction of surgical site infections was seen in our clinical setting as compared to prior randomized trials.