WHO recommendations on Choice of antiseptic agent and method of application for preoperative skin preparation for caesarean section

ABSTRACT

Direct maternal infections around the time of childbirth account for about one tenth of the global burden of maternal death. Women who develop peripartum infections are also prone to severe morbidity, long-term disabilities such as chronic pelvic pain, fallopian tube blockage and secondary infertility. Maternal infections before or during childbirth are also associated with an estimated 1 million newborn deaths annually. Several factors increase the risk of maternal peripartum infections, including pre-existing maternal conditions (e.g. malnutrition, diabetes, obesity, severe anaemia, bacterial vaginosis and group B streptococcus infections), as well as prelabour rupture of membranes, multiple vaginal examinations, manual removal of the placenta, operative vaginal birth and caesarean section. As such, the strategies to reduce maternal peripartum infections and their shortand long-term complications have been directed at improving infection prevention and control practices. Globally, an effective intervention for preventing morbidity and mortality related to maternal infection is the use of antibiotics and antiseptics. However, the misuse of antibiotics for obstetric conditions and procedures is common in many settings. Inappropriate antibiotic use has implications for the global effort to prevent and reduce antimicrobial resistance. The WHO global strategy for containment of antimicrobial resistance underscores the importance of appropriate use of antimicrobials at different levels of the health system to reduce the impact of antimicrobial resistance, while ensuring access to the best treatment available. In 2019, the Executive Guideline Steering Group (GSG) for World Health Organization (WHO) maternal and perinatal health recommendations prioritized updating of the existing WHO recommendations on choice of antiseptic agent and method of application for preoperative skin preparation for caesarean section in response to the availability of new evidence. The recommendations in this document thus supersede the previous WHO recommendations for choice of antiseptic agent and method of application for preoperative skin preparation for caesarean section as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections.