***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : The purpose of the present study was to determine whether the vaginal preparation with povidone – iodine prior to caesarean delivery decreased the incidence of postpartum endometritis . Methods : The present study was a prospect i ve r and omized controlled trial in which subjects received a  vaginal preparation with povidone – iodine solution  immediately prior to caesarean delivery or received  no vaginal preparation . The primary outcome measure was the rate of postpartum endometritis . Results : A significant decrease in post-caesarean endometritis was noted in the group that received the povidone – iodine vaginal preparation ( n = 334 ) compared with the control group ( n = 336 ) [ 6.9 vs. 11.6 % ; RR = 1.69 ; 95 % CI = 1.03–2.76 ] . No statistically significant differences in the incidence of endometritis were noted between the experimental and control groups among women who were not in labor at the time of the caesarean delivery [ 9.2 vs. 8.6 % ; RR = 1.05 ; 95 % CI = 0.58–1.90 ] , and no differences were found between groups when women with ruptured membranes were excluded from the analysis [ 9.6 vs. 6.7 % ; RR = 1.39 ; 95 % CI = 0.78–2.47 ] . Conclusions : Vaginal preparation with povidone – iodine solution immediately prior to a caesarean delivery reduces the risk of post-operative endometritis . This preemptive measure was only found to be beneficial in women whose membranes had ruptured and those who were in labor prior to caesarean surgery Objectives : To determine the carriage rate of enterococcus in the lower genital tract of women having a cesarean delivery and to determine whether a single 2-g intraoperative dose of ampicillin  eradicates enterococcus from the lower genital tract . Methods : Lower genital tract cultures were taken in 84 women who were in labor or had ruptured membranes and who were about to have an indicated cesarean delivery . The subjects were r and omized to receive either a single 2-g dose of ampicillin or a cephalosporin as prophylaxis . Cultures were repeated 24 hours postpartum . Results : Enterococcus was isolated preoperatively in 33 subjects ( 39.3 % ) and postoperatively in 36 ( 42.9 % ) . The enterococcus was eradicated in five of 17 women ( 29.5 % ) who received ampicillin . Conclusion : These results suggest that a single 2-g dose of ampicillin does not eradicate enterococcus from the lower genital tract . ( Obstet Gynecol 1993;81:115 - 7 Abstract Objective : To evaluate the efficacy of preoperative vaginal cleansing using chlorhexidine 0.25 % antiseptic wipes on rates of  postcesarean section ( CS ) infectious morbidities ( endometritis , febrile morbidity and wound infection ) . Methods : This prospect i ve r and omized trial was conducted among 218 pregnant women scheduled for term elective CS . Patients were equally divided into two groups by simple r and omization . After spinal anesthesia and catheterization under aseptic technique , the study group had preoperative vaginal cleansing using chlorhexidine 0.25 % antiseptic wipes for about 1 min , while the control group did not . All cases received the prophylactic antibiotics and the usual abdominal scrub . All participants received the routine postoperative care without other interventions . Adverse postcesarean infectious morbidities such as endometritis , febrile morbidity and wound infection were observed at the time of hospital discharge and weekly for 6 weeks postpartum . Results : Both groups were matched regarding the baseline patients ’ characteristics ( age , gestational age , BMI , operative time and postoperative hospital stay ) . Overall , post-CS infectious morbidity were significantly reduced from 24.4 % in the control group to 8.8 % in the intervention group ; p value < 0.05 . Marked reduction was seen in the incidence of endometritis ( 13.2 % in the control group versus 2.9 % in the intervention group ; p value < 0.05 ) . However , fever and wound infection showed no significant difference between both groups . Conclusion : Cleansing the birth canal with chlorhexidine 0.25 % wipes prior to elective CS appears to be effective in reducing rates of post-CS infectious morbidity mainly endometritis Abstract Objective : To assess the effect of povidone iodine versus benzalkonium chloride , which were applied preoperatively for vaginal disinfection in caesarean sections , on postoperative factors . Methods : One hundred and twenty patients underwent elective caesarean section were divided into three groups using the simple r and omisation method : Group 1 ( povidone iodine , n : 41 ) ; Group 2 ( benzalkonium chloride , n : 39 ) ; Group 3 ( control group , n : 40 ) . Demographic data , duration of operation , amount of bleeding , postoperative pain , time to first flatulence and defaecation , haematological parameters on postoperative day 1 were compared between three groups . Pain evaluation was performed at 6th and 24th postoperative hour using Visual Analogue Scale . Results : No statistically significant differences were detected between the groups in demographic characteristics . There were no significant differences between the groups with respect to the duration of operation and hospital stay . The patients in the group who underwent povidone iodine vaginal cleansing had statistically significantly less postoperative pain as compared to control group . No difference was observed between the groups in haematological parameters other than C-reactive protein ( CRP ) ; however , CRP levels at 24th post-operative hour were significantly lower in Group 1 compared to the other groups . Conclusions : The preoperative vaginal cleansing with povidone iodine could reduce the postoperative pain , analgesic need and infection parameter The introduction of antibiotic prophylaxis for cesarean delivery has decreased the risk of postpartum endometritis and wound infection , but factors that contribute to prophylaxis failure are not understood . To determine factors that might contribute to postpartum infections following antibiotic prophylaxis , we cultured amniotic fluid , decidua , and chorioamniotic membrane specimens for anaerobic and facultative bacteria and for genital mycoplasmas at cesarean delivery . Women were assessed daily for the development of infections , and if endometritis developed , a protected endometrial culture was obtained . Postpartum endometritis developed in 16 and wound infection in four of 102 women .  Infection rates were similar for women receiving cefotetan ( N=50 ) or cefoxitin ( N=52 ) for prophylaxis . The isolation of group B streptococcus { P<.001 ) or Enterococcus faecalis { P=.03 ) from the upper genital tract at delivery was significantly associated with postpartum endometritis . Antibiotic- resistant organisms ( other than enterococci ) were recovered uncommonly at delivery or with postpartum infections . Group B streptococcus was susceptible to the prophylactic agents used , suggesting that virulence factors other than antibiotic resistance are important for the development of postpartum endometritis . Group B streptococcus , E faecalis , and bacteria associated with bacterial vaginosis were recovered from the endometrium at the time of postpartum endometritis OBJECTIVE Our purpose was to determine whether chlorhexidine vaginal irrigation prevents  maternal peripartal infection .  STUDY DESIGN A double-blinded , placebo-controlled , r and omized trial was performed . Single 200 ml irrigations of either 0.2 % chlorhexidine solution or sterile water placebo were given in active labor or before planned cesarean delivery . The primary outcome measure was the combined rate of chorioamnionitis and endometritis ( which were mutually exclusive diagnoses ) . RESULTS A total of 1024 patients were enrolled : 508 in the chlorhexidine group and 516 in the placebo group . The two groups were generally well balanced on important clinical factors but differed ( p < 0.05 ) in rates of nulliparity  ( chlorhexidine 42 % , placebo 52 % ) , intrauterine pressure catheter usage  ( chlorhexidine 65 % , placebo 72 % ) , and presence of meconium  ( chlorhexidine 17 % , placebo 22 % ) . There were no recognized adverse maternal or neonatal reactions to irrigation . Rates of infection ( chorioamnionitis + endometritis ) did not differ significantly between the groups , chlorhexidine 10 % versus placebo 13 % ( relative risk 0.8 , 95 % confidence interval 0.5 to 1.1 ) . Stratified and logistic regression analyses supported the primary univariate analysis . Neonatal outcomes , including sepsis rates of 0.4 % , were equivalent for the groups . CONCLUSION As used in this trial , chlorhexidine lacked efficacy in the prevention of maternal peripartal infection BACKGROUND We found cesarean section ( C-section ) surgical site infection ( SSI ) at our institution was significantly higher than the national benchmark . METHODS A retrospective cohort study was conducted under 4 phases from January 2008-December 2014 .  The hospital infection control ( IC ) policies and a presurgical checklist were bundled and implemented . The study was conducted with 3,334 cesarean deliveries : phase A ( January 1 , 2008-January 31,2010 ) : 1,250 patients without intervention ( baseline SSI rate ) , phase B ( February 1 , 2010-July 31 , 2011 ) : 682 patients were intervened with IC policies  , phase C ( August 1 , 2011-December 31 , 2012 ) : 591 patients with an SSI reduction bundle  , and phase D ( January 1 , 2013-December 31 , 2014 ) : 811 patients were monitored for C-section SSI sustainability . Patients not following strict protocol s because of emergency C-section deliveries were excluded . The χ2 test , Fisher exact test , and st and ard Z test were used for statistical analyses . RESULTS C-section SSI rates were 6.2 % ( 77/1,250 ) in phase A , 3.7 % ( 25/682 ) in phase B , 1.7 % ( 10/591 ) in phase C , and 0.1 % ( 1/811 ) in phase D , respectively . By implementing the IC policies and bundle , the C-section SSI rate was reduced 40.3 % ( phase B vs phase A ) , 72.6 % ( phase C vs phase A ) , and 98.4 % ( phase D vs phase A ) . All statistics were significantly different . CONCLUSIONS We conclude that implementing a C-section SSI reduction bundle was associated with reduced C-section SSI rate down toward zero . A future prospect ively r and omized controlled trial is warranted OBJECTIVE The objective of the study was to determine whether vaginal preparation with povidone iodine before cesarean delivery decreased the risk of postoperative maternal morbidities . STUDY DESIGN The design of the study was a r and omized , controlled trial in women undergoing cesarean delivery with subjects assigned to have a preoperative vaginal cleansing with povidone iodine or to a st and ard care group ( no vaginal wash ) .  The primary outcome was a composite of postoperative fever , endometritis , sepsis , readmission , wound infection , or complication . RESULTS There were 155 vaginal cleansing subjects and 145 control subjects . Overall , 9.0 % developed the composite outcome , with fewer women in the cleansing group ( 6.5 % ) compared with the control group ( 11.7 % ) , although the difference was not statistically significant ( relative risk , 0.55 ; 95 % confidence interval , 0.26 - 1.11 ; P = .11 ) . Length of surgery , being in labor , and having a dilated cervix were all associated with the composite morbidity outcome . CONCLUSION Vaginal cleansing with povidone iodine before cesarean delivery may decrease postoperative morbidities , although the reduction is not statistically significant OBJECTIVE To estimate the efficacy of preoperative administration of intravaginal metronidazole for the prevention of postcesarean endometritis . METHODS This double‐masked , placebo‐controlled  r and omized trial included patients of at least 24 weeks ' gestation undergoing cesarean deliveries for various indications . Patients were r and omized to receive either 5 g of metronidazole gel intravaginally or matching placebo before the initiation of the cesarean . All patients underwent surgical cleansing of the abdomen , and most received prophylactic antibiotics after cord clamping . Patients with chorioamnionitis and /or suspected allergy to metronidazole were excluded . For a two‐sided α of 0.05 and β of 0.20 ( 80 % power ) , 120 subjects were required in each group . The main outcome variable was the incidence of postcesarean endometritis . Secondary outcome variables included presence of febrile morbidity , wound infection , days on antibiotics , and length of postpartum hospitalization . Neonatal outcomes included birth weight 
    Output:
    
No adverse effects were reported with either the povidone-iodine or chlorhexidine vaginal cleansing .
AUTHORS ' CONCLUSIONS Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis .
Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used .