Comparing Pre-Operative Vaginal Preparation with 0.3% Chlorhexidine-Cetrimide Versus 10% Povidone-Iodine on Post-Caesarean Section Infection - A Randomized Controlled Trial.

BACKGROUND: Caesarean section (CS) is one of the most frequently performed surgeries worldwide. Pre-operative vaginal cleansing before caesarean section may reduce bacterial inoculation and subsequent postoperative infections. The objective of the study was to compare the efficacy of pre-operative 0.3% chlorhexidine-cetrimide vaginal cleansing with 10% povidone-iodine in preventing post-caesarean infectious morbidities. METHODOLOGY: This multicentre, single-blind, randomised controlled trial enrolled 250 women undergoing elective or emergency caesarean section. Participants were randomised in a 1:1 ratio to receive pre-operative vaginal cleansing with either chlorhexidine-cetrimide or povidone-iodine. Follow-up occurred until hospital discharge and at two and six weeks postpartum. Data were analysed using SPSS version 28.0, with statistical significance set at p < 0.05. RESULTS: Both antiseptic agents were well tolerated, with no significant adverse effects reported. Compared with the chlorhexidine-cetrimide group, women in the povidone-iodine group had significantly higher rates of postoperative fever (66% vs 34%; p = 0.009) and surgical site infection (69.6% vs 30.4%; p = 0.049). Overall, chlorhexidine-cetrimide was associated with a lower incidence of composite post-caesarean infectious morbidity. CONCLUSION: Both pre-operative vaginal cleansing agents were safe and well tolerated among CS patients. However, chlorhexidine-cetrimide was more effective than povidone-iodine in reducing post-caesarean infectious morbidity, including fever and wound infection.