Hygiene measures during labour

Bibliographic reference Study type Evidence level Number of women Women’s characteristics Intervention Comparison Length of follow-up Outcome measures Effect size Source of funding Additional comments
Lumbiganon 2005117SR1++N=3012 (3 trials)women in labourchlorhexidine vaginal douching during labourplacebo or other vaginal disinfectantN/A1. Maternal outcomes

(a) chorioamnionitis (variously defined by the authors);

(b) intrapartum fever;

(c) intrapartum treatment with antibiotics;

(d) postpartum endometritis (variously defined by the authors);

(e) maternal side-effects (vaginal irritation, thrush, antimicrobial resistance);

(f) serious maternal complication of treatment (e.g. anaphylaxis);

(g) laparotomy for infection;

(h) hysterectomy;

(i) maternal death;

(j) satisfaction with care;

(k) length of hospital stay;

(l) postnatal depression;

(m) successful breastfeeding (variously defined by the authors);

(n) costs of care;

(o) antimicrobial resistance.

2. Neonatal outcomes

(a) ophthalmia neonatorum;

(b) neonatal pneumonia by clinical assessment and/or chest X-ray;

(c) neonatal meningitis by clinical assessment and/or culture;

(d) blood culture confirming sepsis;

(e) neonatal sepsis (variously defined by the authors);

(f) admission to neonatal intensive care unit;

(g) length of hospital stay;

(h) perinatal mortality;

(i) abnormal neurodevelopmental assessment at follow up.
Maternal outcomes

chlorioamnionitis RR 1.10 [0.86 to 1.42]

postpartum endometritis RR 0.83 [0.61 to 1.13]

no report about the other maternal outcomes and side-effects of chlorhexidine in these three trials.

Neonatal outcomes

neonatal pneumonia RR 0.33 [0.01 to 8.09]

neonatal meningitis RR 0.34 [0.01 to 8.29]

blood culture confirming sepsis RR 0.75 [0.17 to 3.35]

perinatal mortality RR 1.00 [0.17 to 5.79]

neonatal sepsis RR 0.75 [0.17 to 3.35]

newborns to receive antibiotics RR 1.65 [0.73 to 3.74]

There was no report about the other neonatal outcomes and side-effects of chlorhexidine in these three trials.
WHO, Khon Kaen University, Thailand and Thomas Jefferson University, USAAll trials in the US
Keane 1998118Cohort2+N=3905 (Cetrimide/chlorhexidine N=1813, Tap water N=2092)pregnant women in labourtap water for perineal cleaningcetrimide/chlorhexidineN/AMaternal morbidity

Fetal morbidity
Temp>38degree OR 1.2 [0.8 to 1.9]

use of antibiotics OR 1.02 [0.86 to 1.2]

perineal infection OR 1.4 [0.77 to 2.7]

perineal breakdown OR 5.8 [0.3 to 999]

Caesarean wound infection OR 1.3 [0.8 to 2.0]

Neonatal Temp>38 OR 1.4 [0.66 to 3.0]

use of antibiotics OR 0.99 [0.82 to 1.2]

eye infection OR 1.1 [0.78 to 1.7]

cord infection OR 1.3 [0.7 to 2.1]
Nil statedUK
Kovavisarach 1998119RCT1−N=2058 (Double-gloving: 1,316 Single-gloving:742)Surgical Gloves used in PerineorrhaphyDouble-glovingSingle-glovingN/APerforation rateAll Double Gloving: 5.9%

Inner Double Gloving: 2.7%

Single Gloving: 6.7%

Inner vs. Double p<0.05
Not statedThailand
Punyatanasak chai 2004120RCT1−N=300 (150 sets for double-gloving, 150 sets for single-gloving)Gloves used in EpisiotomyDouble-glovingSingle-glovingN/Aperforation ratesDouble inner glove: 4.6% (p<0.05)

Double outer glove: 22.6%

Single glove: 18%
Not statedThailand
Kabukuba 1993121Case-series3N=80Doctors and Midwives during obstetric procedureswearing arm sleevewithout wearing arm sleeveN/AContamination rates

Use satisfaction
Contamination rates

Hands: 3.8%, Arms: 5%, Total: 5%, compared with results from other study (Hands: 23.5%, Arms: 30.1%, Total: 42%)

Thought the sleeve had served its purpose: 80%

Would use it regularly: 76%
Not statedUK

From: Evidence tables

Cover of Intrapartum Care
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth.
NICE Clinical Guidelines, No. 55.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Sep.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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