Abstract
Objective: The purpose of this study was to determine if a dilute solution of chlorhexidine used as a one-time vaginal wash intrapartum can reduce the use of postnatal antibiotics and neonatal infection.
Methods: Term pregnant women in labor were prospectively randomized to receive either 20 cc of 0.4% chlorhexidine (n = 481) or 20 cc of sterile water (n = 466) placebo. Exclusion criteria included fetal distress, clinical infection, cervical dilatation >6 cm, and known allergy to chlorhexidine. Outcome variables included the incidence of neonatal pneumonia, culture proven neonatal sepsis, and use of the antibiotics in the neonate. Continuous variables were compared using the Mann-Whitney U-test and discrete variables were compared with the chi-square test.
Results: The length of ruptured membranes (mean ± S.D.) between the chlorhexidine group (408 ± 589 min) and control group (352 ± 318 min) was not significantly different (P = 0.85, 95% confidence interval 354–462). Fifteen neonates (3.2%) in the chlorhexidine group and 9 (1.9%) in the control group received antibiotics in the postnatal period (P = 0.32, 95% confidence interval 0.72–3.72). There was one case of pneumonia in the control group and no cases of sepsis in either group.
Conclusions: A one-time chlorhexidine vaginal wash does not decrease the use of antibiotics or incidence of neonatal infection in our population.
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Selected References
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- Burman L. G., Christensen P., Christensen K., Fryklund B., Helgesson A. M., Svenningsen N. W., Tullus K. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. The Swedish Chlorhexidine Study Group. Lancet. 1992 Jul 11;340(8811):65–69. doi: 10.1016/0140-6736(92)90393-h. [DOI] [PubMed] [Google Scholar]
- Christensen K. K., Christensen P., Dykes A. K., Kahlmeter G. Chlorhexidine for prevention of neonatal colonization with group B streptococci. III. Effect of vaginal washing with chlorhexidine before rupture of the membranes. Eur J Obstet Gynecol Reprod Biol. 1985 Apr;19(4):231–236. doi: 10.1016/0028-2243(85)90034-6. [DOI] [PubMed] [Google Scholar]
- Christensen K. K., Christensen P., Dykes A. K., Kahlmeter G., Kurl D. N., Lindén V. Chlorhexidine for prevention of neonatal colonization with group B streptococci. I. In vitro effect of chlorhexidine on group B streptococci. Eur J Obstet Gynecol Reprod Biol. 1983 Nov;16(3):157–165. doi: 10.1016/0028-2243(83)90095-3. [DOI] [PubMed] [Google Scholar]
- Cowen J., Ellis S. H., McAinsh J. Absorption of chlorhexidine from the intact skin of newborn infants. Arch Dis Child. 1979 May;54(5):379–383. doi: 10.1136/adc.54.5.379. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dykes A. K., Christensen K. K., Christensen P., Kahlmeter G. Chlorhexidine for prevention of neonatal colonization with group B streptococci. II. Chlorhexidine concentrations and recovery of group B streptococci following vaginal washing in pregnant women. Eur J Obstet Gynecol Reprod Biol. 1983 Nov;16(3):167–172. doi: 10.1016/0028-2243(83)90096-5. [DOI] [PubMed] [Google Scholar]
- Gongwer L. E., Hubben K., Lenkiewicz R. S., Hart E. R., Cockrell B. Y. The effects of daily bathing of neonatal rhesus monkeys with an antimicrobial skin cleanser containing chlorhexidine gluconate. Toxicol Appl Pharmacol. 1980 Feb;52(2):255–261. doi: 10.1016/0041-008x(80)90112-x. [DOI] [PubMed] [Google Scholar]
- Hauth J. C., Gilstrap L. C., 3rd, Hankins G. D., Connor K. D. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol. 1985 Jul;66(1):59–62. [PubMed] [Google Scholar]
- Henrichsen T., Lindemann R., Svenningsen L., Hjelle K. Prevention of neonatal infections by vaginal chlorhexidine disinfection during labour. Acta Paediatr. 1994 Sep;83(9):923–926. doi: 10.1111/j.1651-2227.1994.tb13172.x. [DOI] [PubMed] [Google Scholar]
- Kollée L. A., Speyer I., van Kuijck M. A., Koopman R., Dony J. M., Bakker J. H., Wintermans R. G. Prevention of group B streptococci transmission during delivery by vaginal application of chlorhexidine gel. Eur J Obstet Gynecol Reprod Biol. 1989 Apr;31(1):47–51. doi: 10.1016/0028-2243(89)90025-7. [DOI] [PubMed] [Google Scholar]
- Rouse D. J., Hauth J. C., Andrews W. W., Mills B. B., Maher J. E. Chlorhexidine vaginal irrigation for the prevention of peripartal infection: a placebo-controlled randomized clinical trial. Am J Obstet Gynecol. 1997 Mar;176(3):617–622. doi: 10.1016/s0002-9378(97)70557-x. [DOI] [PubMed] [Google Scholar]
- Sweeten K. M., Eriksen N. L., Blanco J. D. Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection. Am J Obstet Gynecol. 1997 Feb;176(2):426–430. doi: 10.1016/s0002-9378(97)70510-6. [DOI] [PubMed] [Google Scholar]
- Vorherr H., Vorherr U. F., Mehta P., Ulrich J. A., Messer R. H. Antimicrobial effect of chlorhexidine and povidone-iodine on vaginal bacteria. J Infect. 1984 May;8(3):195–199. doi: 10.1016/s0163-4453(84)93811-8. [DOI] [PubMed] [Google Scholar]
