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Reducing endometriosis and preventing sepsis at caesarean section

This project assessed the feasibility of introducing new procedures in routine caesarean sections, which may reduce the risk of infection, endometriosis and sepsis. 

Reducing endometriosis and preventing sepsis

Researchers 

Dr Annalise Weckesser oversaw and carried out the qualitative component of this study.

The research team

Hodgetts Morton, V; Wilson, A; Hewitt, C; Weckesser, A; Farmer, N; Lissauer, D; Hardy, P; Morris, R K.

Research background 

One in four women has a caesarean section. Most women recover quickly and without complications. However, some women develop an infection; this may be inside the womb, in the scar on the skin or a severe infection that is present in the bloodstream. Developing an infection makes women's recovery following caesarean more difficult and complicated. The antiseptic solution that is applied to the abdomen to clean the skin and reduce the risk of infection before a caesarean section can also be applied inside the vagina. The antiseptic solution is routinely used for some surgical procedures in pregnancy and is safe.

Research aims 

The study aims to assess the feasibility of a randomised of vaginal cleansing with an antiseptic solution before elective and emergency caesarean section.

Research methods

The study asked women to randomly have either the cleansing of the vagina with the antiseptic solution or no cleansing (standard practice) if they are having a caesarean section. Women were then asked to receive a follow-up telephone interview at 4-6 weeks postdelivery to review if any infection has developed. Focus groups and telephone interviews were also carried out with women who had had caesarean sections to explore their priorities in relation to infection prevention as well as their views on the acceptability of this trial.

Results

The study found that a randomised controlled trial of vaginal cleansing with an antiseptic solution before elective and emergency caesarean section (CS) is feasible. The qualitative study found Women undergoing a CS want more information on what constitutes a ‘normal’ post-operative recovery and specifically would welcome written information and infection prevention advice. The PREPS team incorporated findings regarding consent pathways for recruiting women into intrapartum research and developed two patient-reported outcomes to collect in the main trial.

Publications

Weckesser, Annalise & Farmer, Nicola & Dam, Rinita & Wilson, Amie & Morton, Victoria & Morris, R.. (2019). Women’s perspectives on caesarean section recovery, infection and the PREPS trial: a qualitative pilot study. BMC Pregnancy and Childbirth. 19. 10.1186/s12884-019-2402-8. Link: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2402-8

Victoria Hodgetts-Morton, Catherine A. Hewitt, Amie Wilson, Nicola Farmer, Annalise Weckesser, Emily Dixon, Peter Brocklehurst, Pollyanna Hardy, Rachel K. Morris. (2019) Vaginal preparation with chlorhexidine at cesarean section to reduce endometritis and prevent sepsis: A randomised pilot trial (PREPS), AOGS. Link: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/aogs.13737