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• W2891100262 abstract "Although chlorhexidine gluconate has proven to be superior to povidone iodine for surgical site antisepsis, povidone iodine is the only FDA-approved antiseptic solution for surgical preparation of the vagina.Many surgeons are hesitant to use chlorhexidine gluconate for preoperative vaginal cleansing due to the alcohol dissolvent present in the solutions that is implicated in a greater risk of irritation. Yet, there has been no randomized study to illustrate whether the risk of vaginal irritation is greater in 4% chlorhexidine gluconate versus 7.5% povidone iodine. Thus, the purpose of this study is to compare the tolerance of 4% chlorhexidine gluconate/4% isopropyl alcohol (CHG) versus 7.5% povidone-iodine (PI) vaginal cleansing solutions in adult women undergoing scheduled hysteroscopies, gynecologic dilation and curettage and endometrial ablations between July 2017 and April 2018. Single-blinded prospective randomized control trial. All eligible patients were approached for enrollment. Consented patients underwent simple randomization into one of two groups: (1) PI or (2) CHG antiseptic as vaginal preparation. Patients completed a standardized survey evaluating vaginal symptoms (dryness, burning, itchiness, unusual discharge) and urinary symptoms (pain or burning with urination) at three time points: preoperatively (T0), immediately postoperatively (T1), and 24 to 48 hours postoperatively (T2). Adjusted odds ratios (aOR), controlling for age, menopause, catheterization, and T0 scores, were calculated. A total of 123 patients (PI n=63, CHG n =60) met inclusion criteria. At T1, patients treated with CHG were significantly more likely to experience dryness (aOR, 4.44; 95% CI 1.06-17.96; p=0.0416), vaginal burning (aOR 6.45; 95% CI 2.33-17.86; p=0.0003), and pain with urination (aOR, 3.30; 95% CI 1.18-9.19; p=0.0224). In total at T1, 54.2% of CHG vs. 34.9% of PI patients had adverse symptoms. At T2, significantly more patients receiving CHG noted vaginal burning (aOR 5.05; 95% CI 1.85-13.78; p=0.0016), pain with urination (aOR 4.78; 95% CI 1.66-13.78; p=0.0037), and unusual discharge (aOR 3.56; 95% CI 1.13-11.26; p=0.0303). In total at T2, 68.8% CHG vs. 43.8% PI patients experienced adverse symptoms. The use of chlorhexidine vaginal preparation is associated with significantly worse vaginal and urinary symptoms when compared with povidone-iodine, both in the immediate postoperative period and 24 to 48 hours postoperatively. This is the first RCT comparing the tolerance of 4% chlorhexidine gluconate to 7.5% povidone-iodine using patient-reported outcomes. Patients undergoing procedures that require vaginal CHG prophylaxis should be warned about the high incidence of postoperative vaginal and urinary symptoms." @default.
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• W2891100262 date "2018-09-01" @default.
• W2891100262 modified "2023-09-27" @default.
• W2891100262 title "RCT: tolerance of chlorhexidine gluconate versus povidone-iodine vaginal cleansing solution" @default.
• W2891100262 doi "https://doi.org/10.1016/j.fertnstert.2018.07.127" @default.
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