Background: Cesarean delivery is the commonest surgical procedure practiced by Obstetricians and its incidence continues to rise. It is associated with significant morbidity, and infection is one of the most common postoperative complications. Different interventions are described to decrease the rate of infection. The use of vaginal antiseptics and antimicrobial was prescribed. However, the results are inconsistent.
The aim of the work: The current work aimed to determine the value of pre-surgical vaginal cleaning by a 5% chlorhexidine gluconate solution could reduce the risk of maternal infections after cesarean delivery.
Patients and Methods: This study included 400 women attending obstetrics and gynecology departments to deliver by elective cesarean section. The study had been completed between the beginning of January 2019 to the end of December 2021. All women were randomized to one of two equal groups. The first included 200 women where no wash was done (Control group). The second included another 200 cases where wash with chlorhexidine gluconate was done (Study group).  At the time of hospital discharge and again at one month post delivery. The rate of endometritis and different wound complications were documented and compared between groups.
Results: The control and study groups were comparable regarding female age, parity, gestational age at delivery, primary cesarean section, operative time. However, postoperative hospital stay duration was significantly longer in control than the study group (43.26±10.62 vs. 39.69±9.21 hours, respectively). Hemoglobin concentrations revealed non-significant difference between the study and the control groups before and after cesarean delivery. However, it was significantly reduced in both groups after surgery than values before surgery. Endometritis was reported among 12.5% of the control group, compared to 7.0% of the study group, with no significant difference between the study and the control groups. However, the overall wound complications were significantly increased among control than study group and composite complications were also significantly increased in control than the study group (12.0% vs 4.0% respectively). Lower preoperative hemoglobin was the only significant associated factor for development of endometritis.
Conclusion: Peroperative vaginal preparation with 5.0% chlorhexidine gluconate solution is associated with a reduction in post-cesarean infectious complications (mainly endometritis) wound infection and other wound-related complications. It is recommended to be a routine practice before cesarean delivery.