Prepping the vagina before cesarean delivery.
"SHOULD YOU ADOPT THE PRACTICE OF VAGINAL CLEANSING WITH POVIDONE-IODINE PRIOR TO CESAREAN DELIVERY?"
ROBERT L. BARBIERI, MD (EDITORIAL; JANUARY 2016)
"PREVENTING INFECTION AFTER CESAREAN DELIVERY: 5 MORE EVIDENCE-BASED MEASURES TO CONSIDER"
KATHRYN E. PATRICK, MD; SARA L. DEATSMAN, MD; AND PATRICK DUFF, MD (DECEMBER 2016)
I enjoyed your review of the topic. I am interested in using vaginal preparation prior to cesarean in the settings of active-phase and second-stage arrest. This should be most valuable since we anticipate possible prolonged attempt at head delivery. There may be a need for head elevation as well. Of course, we have become enthusiastic about using reverse breech extraction in difficult cases since your article a few years ago. I have yet to do a Patwardhan maneuver. That seems to rely on rotating the spine anteriorly to get the second arm out. With the head impaction, there is limited range for neck rotation. With vaginal preparation, is there any concern about fetal exposure to iodine?
Kimberly Harney, MD
>> Dr. Barbieri responds
Dr. Harney raises the important issue of the potential adverse effects of povidone-iodine surgical preparation when used on a pregnant woman with ruptured membranes. There is very little direct evidence of a toxic effect of povidone-iodine on the fetus, but studies on women report that there is a transient increase in circulating iodine and iodine excretion following a vaginal povidone-iodine preparation. (1) The American College of Obstetricians and Gynecologists has suggested that chlorhexidine might be a superior vaginal disinfectant than povidone-iodine, (2) but chlorhexidine is not approved by the US Food and Drug Administration for use in the vagina, and many surgical nursing directors favor the use of povidone-iodine in the vagina. (3)
(1.) Velasco I, Naranjo S, Lopez-Pedrera C, Garriga MJ, Garcia-Fuentes E, Soriquer F. Use of povidine-iodine during the first trimester of pregnancy: a correct practice? BJOG. 2009;116(3):452-455.
(2.) Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists. Committee Opinion No. 571: solutions for surgical preparation of the vagina. Obstet Gynecol. 2013;122(3):718-720.
(3.) Guideline for preoperative patient skin antisepsis. In: Guidelines for perioperative practice. Denver, CO: Association of Perioperative Registered Nurses, Inc; 2014.
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|Title Annotation:||Comment & Controversy|
|Article Type:||Letter to the editor|
|Date:||May 1, 2017|
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