New systematic review on chlorhexidine

It felt rather fitting to have spotted this new systematic review and meta-analysis in the same week that I was speaking about my newly updated Group B Strep Explained book!

Freely availably in BMC Pregnancy and Childbirth, the paper by Bell et al (2018) reviews the effectiveness of intrapartum vaginal chlorhexidine in the reduction of maternal and neonatal colonisation and infectious morbidity. They did not find any effect, but note that this may be due to the limitations of the studies and suggest that there is ample justification to carry out further research.

Here’s the abstract and link if you’d like to look more closely: What is the result of vaginal cleansing with chlorhexidine during labour on maternal and neonatal infections? A systematic review of randomised trials with meta-analysis.

 

The Research

In this updated second edition of her popular book, Dr Sara Wickham discusses the different perspectives on GBS, the screening and prevention options that are available, the wider issues relating to this area, the alternative paths that some people take, the answers to parents’ most frequently asked questions and more.

Background: Infection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity. The objective of this systematic review is to review the effectiveness of intrapartum vaginal chlorhexidine in the reduction of maternal and neonatal colonisation and infectious morbidity.

Methods: Search strategy – Eight databases were searched for articles published in any language from inception to October 2016. Selection criteria – Randomised controlled trials were included. Data Collection and analysis – Publications were assessed for inclusion. Data were extracted and assessed for risk of bias. Relative risks from individual studies were pooled using a random effects model and the heterogeneity of treatment was evaluated using Chi2 and I2 tests.

Results: Eleven randomised controlled trials (n = 20,101) evaluated intrapartum vaginal chlorhexidine interventions. Meta-analysis found no significant differences between the intervention and control groups for any of the four outcomes: maternal or neonatal colonization or infection. The preferred method for chlorhexidine administration was vaginal irrigation.

Conclusions: Meta-analysis did not demonstrate improved maternal or neonatal outcomes with intrapartum vaginal chlorhexidine cleansing, however this may be due to the limitations of the available studies. A larger, multicentre randomised controlled trial, powered to accurately evaluate the effect of intrapartum vaginal chlorhexidine cleansing on neonatal outcomes may still be informative; the technique of douching may be the most promising.

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Bell C, Hughes L, Akister T et al (2018). What is the result of vaginal cleansing with chlorhexidine during labour on maternal and neonatal infections? A systematic review of randomised trials with meta-analysis.BMC Pregnancy and Childbirth 18:139. https://doi.org/10.1186/s12884-018-1754-9
photo credit: mclcbooks Apart from the crowd via photopin (license)

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