EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Abdallah
EVALUATION OF THE RISK OF POSTCESAREAN ENDOMETRITIS
WITH PREOPERATIVE VAGINAL PREPARATION WITH POVIDONEIODINE: A RANDOMIZED CONTROLLED STUDY
By
Ameer Ahamed Abdallah, MD
ABSTRACT:
Objective: To investigated the effect of preoperative vaginal preparation with
povidone-iodine as a preventive intervention against postcesarean endometritis and
wound infection.
Design: Randomized controlled study.
Setting: Suzan Mubarak University Hospital, Egypt& Aramco Hospital, Saudia
Arabia.
Patients: 400 women undergoing nonemergent cesarean delivery. Subjects received
either standard abdominal scrub alone or abdominal scrub with an additional vaginal
preparation with povidone-iodine solution. All subjects received prophylactic
antibiotic preoperatively.
Interventions: Each subject’s postoperative course was reviewed for development of
febrile morbidity (temperature > 38.0"C), endometritis (temperature > 38.4°C
accompanied by fundal tenderness occurring beyond the first postoperative day, in
the absence of evidence of other infection), and wound infection.
Results: Postcesarean endometritis occurred in 7.0% of subjects who received a
preoperative vaginal preparation and 14.5% of controls (P < .05). There was no
measurable effect of a vaginal scrub on the development of postoperative fever or
wound infection. The adjusted odds ratio for developing endometritis after a vaginal
preparation was 0.44 (95% confidence interval (CI) 0.193- 0.997). Multivariate
analysis showed an increased risk of developing endometritis in association with
severe anemia (adjusted OR 4.26, 95% Cl 1.568 -11.582), use of intrapartum internal
monitors (adjusted OR 2.84, 95% Cl 1.311- 6.136), or history of antenatal
genitourinary infection (adjusted OR 2.9, 95% CI 1.265- 6.596).
Conclusion: Preoperative vaginal scrub with povidone –iodine decreases the
incidence of postcesarean endometritis. This intervention does not seem to decrease
the overall risk of postoperative fever or wound infection.
KEY WORDS:
Postcesarean Endometritis
Povidone-Iodine.
Preoperative Vaginal
85%. The most recognized risk factors
for developing postcesarean endometritis involve pathways that introduce
large quantities of bacteria into the
uterine cavity. These include a large
number of vaginal examinations in
labor, prolonged duration of active
labor, prolonged membrane rupture,
and failure to use antimicrobial
prophylaxis4. Other reported risk
INTRODUCTION:
Postcesarean endometritis and
wound infection remain significant
morbidities, despite use of strategies to
prevent these complications with
respect to patient cost, prolonged
hospital stay, use of parenteral
antibiotics, and patient discomfort1.
The risk of postcesarean infectious
morbidity is reported to range from 5-
239
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
factors include nulliparity, use of
internal monitors in labor, adolescence,
presence of intrapartum bacterial
vaginosis, and the presence of an
immunocompromised state such as
diabetes
mellitus
or
human
immunodeficiency virus infection4-6.
The pathophysiology is theoretically an
ascending polymicrobial infection of
cervical and vaginal organisms into the
uterus, with hematogenous spread
through exposed edges of incised
myometrium. The bacterial species
implicate in postcesarean endometritis
and wound infection includes gramnegative bacilli, aerobic and anaerobic
gram-positive cocci, and anaerobic
bacilli associated with bacterial
vaginosis7-9.
Abdallah
through March 2010. A11 women who
were to undergo nonemergent cesarean
delivery were eligible for recruitment,
excluding those with placenta previa or
a diagnosis of chorioamnionitis.
Eligible patients were approached for
the study at the time of admission for
an elective cesarean delivery or, in the
case of laboring patients, at the time
the decision for cesarean delivery was
made. After informed consent was
obtained, each patient was assigned to
receive a standard abdominal skin
preparation with povidone-iodine
solution or the standard abdominal
preparation plus an additional 30second vaginal scrub with povidoneiodine solution.
Vaginal preparation was performed at
the time of the abdominal scrub with
povidone-iodine solution. Each sponge
was rotated 360 degrees in the vagina
such that the entire process lasted
about 30 seconds. All patients received
a single dose of parenteral antibiotic
prophylaxis.
There is evidence in the
literature to support the use of
preoperative vaginal scrub with
povidone-iodine before a hysterectomy
to decrease the incidence of
postoperative infectious morbidity10.
Vaginal preparation has been shown to
decrease the quantitative load of
vaginal microorganisms as well as to
remove certain species of bacteria11,13.
There is limited information in the
literature regarding the 'use of
preoperative vaginal preparation with
povidone-iodine as a prophylactic
measure
against
postcesarean
infectious morbidity13. ”In this
randomized controlled trial,
the
hypothesis that vaginal preparation
with povidone - iodine scrub before a
cesarean delivery will decrease the
incidence of postoperative endometritis, wound infection, and overall
postoperative febrile morbidity was
prospectively investigated.
After the patients were
discharged from the hospital and
completed a 6-Week puerperal period,
their charts were reviewed for
development of postoperative febrile
morbidity, diagnosis of endometritis,
or diagnosis of wound infection,
Febrile morbidity was defined as any
postoperative temperature greater than
38°C.Endometritis was defined by a
temperature elevation greater than
38.4°C persisting beyond the first
postoperative day, in association with
uterine tenderness and foul lochia, in
the absence -of physical or laboratory
evidence of other infection. Wound
infection was a clinical diagnosis,
evidenced by erythema or wound edge
separation with purulent drainage. This
last diagnosis also included such
entities as wound dehiscence and
necrotizing fasciitis, Cases of skin
MATERIALS AND METHODS:
Eligible patients were recruited
at Suzan Mubarak University
Hospital, Egypt & Aramco Hospital,
Saudia Arabia from November 2006
240
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
separation without evidence of
cellulitis were not included, because
this information was not consistently
available in the hospital charts.
Analysis of the number of patients with
endometritis was as a subgroup of
patients with febrile morbidity.
Because febrile morbidity, endometritis, and wound infection were
defined as the primary outcomes for
this study, data were not collected with
respect
to
other
sources
of
postoperative fever such as urinary
tract infection, pneumonia, atelectasis,
or drug fever. Appropriate antibiotic
therapy was initiated for patients with a
clear diagnosis of infection, whether
pelvic or non pelvic in origin. At our
hospital, outpatients who are diagnosed
with postoperative wound infections
are admitted to the hospital for initial
intravenous antibiotic therapy and
wound care, therefore documentation
of this complication is available in
their hospital charts.
Abdallah
Measurement
bias
was
minimized because the physicians who
evaluated
all
patients
with
postoperative fever were unaware of
any patient’s participation in the study.
This was possible because, at any
given time, the postpartum service was
a completely different team of
physicians from that which staffed the
labor and delivery unit, where patient
enrollment took place. Reporting bias
was minimal, because all hospital
charts
were
reviewed
without
knowledge of patient assignment to
either arm of the study.
RESULTS:
Four hundred patients were
recruited into the study, Thirty-three
subjects were excluded because their
assignment envelopes that contained
patient identification were lost, and no
patient information was available. Of
these unidentified subjects, 21 had
been randomly assigned to receive a
vaginal scrub, as indicated by the
envelope assignment number. Hospital
charts were unable to be located for 53
additional patients, 28 of whom had
been assigned to the treatment group.
Additionally, 6 subjects were excluded
due to violation of inclusion criteria (5
had intrapartum chorioamnionitis, and
1 patient had a vaginal delivery). In
this last group, 5 patients were
assigned to receive a vaginal scrub.
Ultimately, 92 subjects were excluded
from the final analysis (Fig. 1).
Primary analysis was intention-to-treat
and involved all participants who were
randomly assigned and for whom all
data were available.
Other information abstracted
from the chart review included patient
demographics, parity, gestational age,
indication for cesarean delivery,
history of antenatal genitourinary
infection,
number
of
vaginal
examinations, evidence of prolonged
active labor (> 10 hours)14 and
prolonged ruptured membranes (> 18
hours)15, presence of meconiumstained amniotic fluid, use of internal
monitors in labor, and postoperative
length of stay. Antenatal genitourinary
infections included urinary tract
infections, bacterial vaginosis, or
documented infection with Neisseria
gonorrhoeae or Chlamydia trachomatis. Additionally, hospital charts
were reviewed for the presence of
maternal
comorbid
conditions
including severe anemia (hematocrit <
30%), diabetes, and morbid obesity (>
114 kg).
Complete data were available
for 308 subjects. One hundred sixty-six
subjects were assigned to receive a
standard abdominal scrub, and 142
subjects were assigned to receive an
additional vaginal preparation. Comparison of the control group to the
241
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
treatment group scrub did not
demonstrate a significant difference in
patient
demographics,
pregnancy
Abdallah
history, obstetric characteristics, or
maternal comorbid conditions (Table
1).
Randomized patients
(n=400)
Unidentified patients (n=33)
Vaginal preparations (n=21)
Controls (n=12)
Identified patients
(n=367)
Violations of inclusion (n=6)
Vaginal preparation (n=5)
Control (n=1)
Identified participating patients
(n=361)
Unavailable charts (n=53)
Vaginal preparation (n=28)
Controls (n=25)
Patients available for analysis
(n=308)
Fig. 1.: Flow of study participants included and excluded in trial of vaginal
preparation compared with abdominal scrub only.
Postcesarean
endometritis
occurred in 24 of 166 (14%) of control
patients and in 10 of 142 (7%) patients
who received a preoperative vaginal
scrub (P <, 05). Forty-seven of 166
(28%) control patients and 34 of 142
(24%) patients in the treatment group
developed
postoperative
febrile
morbidity. (P = .437) Wound infection
was an infrequent complication that
developed in 2 (1.2%) control patients
and l (0.7%) patient in the treatment
group. (P=.403) Postoperative length
of stay was similar in the 2 groups. A
postoperative stay that exceeded 4 days
was seen in 14 (8.4%) control patients
and 7(5.0%) of treatment patients (P =
224) (Table 2). Multivariate analysis
indicated several factors that affected
the risk for developing postcesarean
endornetritis. The adjusted odds ratio
(OR) for developing endometritis after
a vaginal scrub was 0.44. (95%
confidence interval [CI] 0193- 0.997).
The risk of developing endometritis
was
significantly
increased
in
242
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
association with severe anemia
(adjusted OR 4.26, 95% CI
l.568~'96ll.582), the use of internal
monitors (adjusted OR 2.84, 95% CI
Abdallah
l.3ll~ 6.l36), or a history of antenatal
genitourinary infection (adjusted OR
2.89, 95% CI 1.265-6.595) (Table 3).
Table 1: Baseline Characteristics of Study Population Compared With Women Who
Received Standard Abdominal Scrub Only
Variable
Age
<20 years
≥ 20 years
Gestational age
≥37weeks
Standard Scrub
n=166
19 (11.4)
147 (88.6)
136 (81.9)
Standard Scrub +
Vaginal Scrub n=142
16(11.3)
126 (88.7)
126 (88.7)
30 (18.1)
16 (11.3)
59 (35.5)
35 (21.1)
24 (14.5)
28 (16.9)
4 (2.4)
6 (3.6)
8 (4.8)
30 (18.1)
98 (59.0)
60 (42.2)
39 (27.5)
l2(8.5)
14 (9.9)
3 (2.1)
8 (5.6)
2 (1.4)
23 (16.2)
79 (55.6)
4 (8.4)
45 (27.1)
13 (7.8)
44 (26.5)
132 (79.5)
11 (7.7)
38 (26.8)
19 (13.4)
25 (17.6)
118 (83.1)
32 (19.3)
53 (31.9)
7 (4.2)
16 (9.6)
24 (16.9)
56 (39.4)
11 (7.7)
14 (9.9)
< 37 weeks
Indication for Cesarean
Elective repeat
Arrested labor
Fetal distress
Fetal Malpresentation
Suspected Macrosomia
Previous Myomectomy
Multifetal Gestation
History of antenatal Infection
Severe anemia
(Hematocrit < 30%).
Meconium-stained Amniotic fluid
Intrapartum internal Monitors
Diabetes mellitus
Maternal obesity (Weight >114 kg)
Number of intrapartum vaginal
examination ≤5
>5
Intact membranes
Prolonged rupture Of membranes
Prolonged active Labor
Table 2: Postcesarean Outcomes in Study Group Compared With Control
Outcome
Endometritis
Febrile morbidity
Wound infection
Postoperative length Of stay
≥4d
>4d
24 (14.5)
47 (28.3)
2 (1.2)
Standard +
Vaginal Scrub
n = 142
10 (7.0)
34 (23.9)
l (0.7)
152 (91.5)
14 (8.4)
135 (95.0)
7 (5.0)
Standard Scrub
n = 166
243
P
.045
.437
.403
.224
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
Abdallah
Table 3: Multivariate Analysis of Factors Affecting Risk for Postcesarean
Endometritis
(N = 308)
Variable
Vaginal scrub
Severe anemia (hematocrit < 30%)
Use of intrapartum internal monitors
History of antenatal genitourinary infections
Adjusted Odds
Ratio
0.44
4.26
2.84
2.89
95% Confidence
Interval
0.193-0.997
1.568-11.582
1.311-6.136
l.265-6.595
teristics that seem to contribute to the
development of postcesarean endometritis include age and socioeconomic status, with the highest rate of
infection developing in indigent young
women3. Additionally, the presence of
bacterial vaginosis or other concurrent
vaginal infection predisposes the
patient to an ascending infection6,7.
Watts et al found a 6-fold increase of
postcesarean
endometritis
when
bacterial vaginosis was associated with
delivery.
DISCUSSION:
The concept of vaginal antisepsis
is not new to the field of gynecology.
Since the 1970s, it has been
demonstrated that a povidone-iodine
vaginal scrub before vaginal surgery or
abdominal hysterectomy is associated
with lower postoperative infectious
morbidity16. Osborne and Wright11
showed that a preoperative povidoneiodine vaginal scrub decreased the total
number of bacterial species in the
vagina by at least 98%. A preoperative
vaginal scrub with povidone-iodine
was shown to remove anaerobic grampositive bacilli and dramatically
decrease the quantities of gramnegative bacilli and aerobic and
anaerobic
gram-positive
cocci,
12
especially Enterococcus species .
Strategies to decrease the incidence of postcesarean endometritis are
currently being used, including
conscientious surgical technique and
the routine use of antibiotic prophylaxis. Despite these interventions,
infectious morbidity after a cesarean
delivery remains significant4, 5, and 7.
Risk factors for developing
postcesarean endometritis have been
recognized, and all involve an
increased risk of exposure of the upper
genital tract to lower tract bacteria. A
large number of vaginal examinations
in labor have the strongest association
with postoperative infection, likely due
to an increased size and speed of entry
of bacterial inoculums from the vagina
into the uterus1-15. Other frequently
described obstetric risk factors for
postcesarean infection include prolonged labor, prolonged membrane
rupture, and the use of internal
monitoring2,4,7,8,14. Maternal charac-
The
effectiveness
of
prophylactic parenteral antibiotics has
been well demonstrated in the
literature, with cumulative data suggesting a reduction in postcesarean
endometritis of approximately 50% in
a given institution. The eradication of
infection is thus incomplete, with a
resultant postcesarean endometritis rate
of 10 - 20% despite the use of
prophylactic antibiotics5, 7. Prophylaxis
failure with increased doses of
cefazolin has been reported, and may
be due to a shift in vaginal flora with a
244
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
dominance of organisms resistant to
cefazolin, such as Enterococcus4,5,8.
Abdallah
increased
risk
of
postcesarean
endometritis. Differences in reported
postoperative endometritis rates could
be attributed to the technique and
materials used for the vaginal
preparation itself perhaps subtle
differences in contact time and
distribution of povidone-iodine within
the vagina, or the amount of antiseptic
used for the preparation might affect
infectious outcomes.
Recent studies have investigated specific preoperative interventions to decrease the risk of
postcesarean
endometritis.
One
published study also investigated the
use of preoperative vaginal preparation
with povidone-iodine before cesarean
delivery13. Reid et al13 reported that
vaginal preparation did not affect the
incidence of postoperative fever,
endometritis, or wound infection,
however, that study did not address
several potential risks for increased
exposure to infection, specifically, a
history of antenatal genitourinary
infection, use of intrapartum internal
monitors, severe anemia, or presence
of diabetes mellitus or obesity. Also,
that study did not indicate whether all
participants
received
parenteral
prophylactic antibiotic at the time of
umbilical cord clamping.
Several limitations have been
identified in the assignment of this
randomized study. The total number
and demographic data of patients who
underwent cesarean delivery during the
study period is unknown, therefore it is
also unknown whether we obtained a
valid representation of our eligible
patient pool. There was a large amount
of data that was lost due to the
unavailability of hospital charts. These
data were balanced with respect to the
number of subjects assigned to each
arm of the trial. However, there was an
additional large imbalanced loss of
information for the subjects excluded
for violation of recruitment criteria and
for the unidentified subjects for whom
no data are available. In these latter 2
groups of
Pitt et al17 reported that the use
of preoperative intravaginal metronidazole gel reduced the incidence of
postcesarean endometritis, presumably
by reducing the local exposure of
anaerobic bacteria during a cesarean
delivery. This finding supports our
hypothesis that, similar to antisepsis
before a hysterectomy, postcesarean
infection rates may be improved by
reducing the vaginal bacterial load
preoperatively.
Patients, more information was
lost for the treatment arm of the trial.
Finally, the power calculation was not
met in the final analysis of available
charts. These shortcomings introduce
the possibility of bias, with a possible
overestimation of the treatment effect
of a preoperative vaginal scrub. With
respect to the assessment of primary
outcomes, we did not collect specific
data about those patients, if any, who
were diagnosed with endometritis
during the first postoperative day, nor
those who may have developed fundal
tenderness and foul lochia but did not
have temperatures that exceeded
38.4°C, and the effect of vaginal
A general interpretation of the
results suggests that a preoperative
vaginal scrub decreases the risk of
postcesarean
endometritis.
This
intervention, however, does not seem
to reduce the overall risk of developing
postoperative febrile morbidity. Within
our model, severe anemia, the use of
internal monitors, and a history of
antenatal genitourinary infections were
independently associated with an
245
EL-MINIA MED. BULL. VOL. 20, NO. 2, JUNE, 2009
preparation within this subgroup is
unknown. Additionally, an examination of nonuterine sources of fever
may be useful in interpreting the
overall incidence of febrile morbidity.
Abdallah
isolates at delivery as predictors of
post-cesarean
infections
among
Women receiving antibiotic prophylaxis. Obstet Gynecol 1991;77:287-92.
6. Gabbe SG, Niebyl JR, Simpson
JL, editors. Obstetrics: normal and
problem pregnancies. 3rd ed. London
(UK): Churchill Livingstone, Inc.;
1996.
7. Watts DH, Krohn MA, Hillier
SL, Eschenbach DA. Bacterial
vaginosis as a risk factor for postcesarean endometritis. Obstet Gynecol
1990; 75:52 – 8.
8. Roberts S, Maccato M, Faro S,
Pinell P. The microbiology of postcesarean Wound morbidity. Obstet
Gynecol 1993; 81:383- 6.
9. Berenson AB, Hammill HA,
Martens MG, Faro S. Bacteriologic
findings of post-cesarean endornetritis
in adolescents. Obstet Gynecol l990;
75:627-9.
10. Eason EL, Sampalis JS,
Hemmings R, Joseph L. Povidone l
iodine gel vaginal antisepsis for
abdominal hysterectomy. Am J Obstet
Gynecol l997; l76:l01l- 6.
11. Osborne NG, Wright RC.
Effect of preoperative scrub on the
bacterial flora of the endocervix and
vagina. Obstet Gynecoll977;50:l48-50.
12. Amstey MS, Jones AP.
Preparation of the vagina for surgery:
a comparison of povidoneiodine and
saline solution.JAMAl98l;245:839-41.
13. Reid VC, Hartmann KE,
McMahon M, Fry EP. Vaginal
preparation with povidone - iodine and
postcesarean infectious morbidity: a
randomized controlled trial. Obstet
Gynecol 2001; 97: l47-52.
14. Cunningham FG, Gant NF,
Leveno KJ, Gilstrap LC IH, Hauth JC,
Wenstrom KD, editors. Williams’s
obstetrics. 21st ed. New York (NY):
McGraw-Hill; 2001.
15. Schrag S, Gorwitz R, FultzButts K, Schuchat A. Prevention of
prenatal Group B Streptococcal
Within study population, this
trial demonstrates a benefit of a
preoperative vaginal scrub just before
cesarean delivery. The incidence of
postcesarean endometritis was signifycantly decreased in those subjects who
were scrubbed with both abdominal
and vaginal povidoneiodine compared
with those who received a standard
abdominal scrub alone. Used in
conjunction with prophylactic antibiotics, a vaginal povidoneiodine preparation may further decrease the number
of bacteria species exposed to the
eridometritmi at the time of uterine
incision,
especially
Enterococcus
species that are resistant to cefazolin
prophylaxis. Further studies are
required to confirm these findings
before a change is practice is instituted.
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DE.
Infections
following cesarean section. Curr Opin
Obstet Gynecol 1993; 5:5 l7-20.
2. Gonik B, Shannon RL,
Shawar R, Costner M, Seibel M. Why
patients fail antibiotic prophylaxis at
cesarean delivery: histologic evidence
for incipient infection. Obstet Gynecol
l99Z; 79:l79-84.
3. Magann EF, Dodson MK,
Ray MA, Harris RL, Martin JN,
Morrision JC. Preoperative skin
preparation and intraoperative pelvic
irrigation: impact on post-cesarean
endometritis and wound infection.
Obstet Gynecol l993; 81:922-5.
4. Chang PL, Newton ER.
Predictors of antibiotic prophylactic
failure in post-cesarean endometritis.
Obstet Gynecol l992; 80: 1 17-22.
5. Watts
DH,
Hillier
SL,
Eschenbach. Upper genital tract
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‫‪AA, Baillie P. Effect of different pre‬‬‫‪operative vaginal preparations on‬‬
‫‪morbidity of patients undergoing‬‬
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‫‪l976; 50:l984-6.‬‬
‫‪17. Pitt C, Sanchez-Ramos L,‬‬
‫‪Kaunitz AM. Adjunctive intravaginal‬‬
‫‪metronidazole for the prevention of‬‬
‫‪postcesarean‬‬
‫‪endometritis:‬‬
‫‪a‬‬
‫‪randomized controlled trial. Obstet‬‬
‫‪Gynecol 200l; 98:745-50.‬‬
‫‪18. Schulz KF, Chalmers l, Hayes‬‬
‫‪RJ, Altman DG. Empirical evidence of‬‬
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‫الملخص العربى‬
‫دراسة عشوائية محكمة حول تأثير إعداد المهبل بالفويدين أيودين قبل إجراء العمليات القيصرية‬
‫غير الطارئة (المخططة مسبقاً)على حدوث التهاب بطانة جدار الرحم‪.‬‬
‫تم إجراء هذه الدراسةة ىةى كةل مةن مستشةفى سةو ان مبةارج الجةامعى مةرا النسةاء‬
‫والتوليد (مصر) ومستشفى أرامكةو (المملكةة العربيةة السةعودية) واشةتملت الدراسةة علةى ‪400‬‬
‫سيدة من الذين كان مةن المقةرر(المخطط لهةم إجةراء عمليةة قيصةرية) وتةم تقسةيم المرىةى إلةى‬
‫مجموعتين ا ولى وتم لها إجراء تعقيم روتينى اعتيادى للبطن بالفوديين أيوديين (التعقيم المثالى‬
‫ىى كل حةاتت جراحةات الةبطن) والمجموعةة الثانيةة تةم لهةا عمةل التعقةيم المعتةاد باإىةاىة إلةى‬
‫إعداد المهبل قبل الجراحة بالبوىيدين أيودين وتم إعطاء مرىى كلتا المجموعتين مىاد حيوى‬
‫كإجراء احترا ى ىد حدوث التهاب ىى بطانة جدار الرحم‪.‬‬
‫تم متابعة مرحلة ما بعد العمليةة (تقيةيم ترتفةا درجةة الحةرارة كثةر مةن ‪ 38.4‬درجةة‬
‫سيل ية) أو حدوث التهاب ىى بطانة جدار الرحم (ارتفا درجة الحرارة كثر من ‪ 38.4‬درجةة‬
‫سيل ية مع وجود ألةم ىةى موىةع قمةة الةرحم) هةذا بعةد اليةوم ا ول بعةد العمليةة مةع اسةتثناء أى‬
‫مصدر آخر للعدوى وكذا متابعة التئام الجرح‪.‬‬
‫وأظهرت النتائج أن ‪ %0.7‬ىقةط (مجموعةة الدراسةة) مةن مرىةى المجموعةة الثانيةة و‬
‫‪( %14.5‬المجموعة الىابطة) (ىارق ذو دتلة إحصائية) حدث لهم التهاب ىى جدار الرحم بعد‬
‫الوتدة‪.‬‬
‫وخلصت الدراسة إلى أن اإعداد المسةب للمهبةل بةالبفوديين أيةوديين قبةل العمليةة القيصةرية‬
‫غير الطارئة يقلل بشكل واىح إمكانية حدوث التهاب ببطانة جدار الرحم ويقلل إجماتً احتمالية‬
‫حدوث ارتفا ىى درجة الحرارة بعد العملية‪.‬‬
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