Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV)
RHL practical aspects by Cutland CL
Implementation of this potentially beneficial intervention would require informed decisions and policy planning by local health authorities and community health-care providers.
FIRST CONTACT (PRIMARY CARE) LEVEL
- Vaginal disinfection with chlorhexidine, with or without newborn skin/umbilical cord cleansing, should be performed only by health-care professionals or community-based birth attendants who manage women in labour.
- Various methods of vaginal disinfection using chlorhexidine solution have been described (1). These include washing the birth canal with 20–200 ml of chlorhexidine solution or using chlorhexidine-soaked swabs or cotton wool as wipes. At the present time it is not known which among the currently used methods is the most effective.
- Chlorhexidine solution should be used in a concentration of 1% or less. One study (2) has reported an unacceptably high rate of maternal complaints with 2% chlorhexidine solution.
- Aqueous, alcohol-free chlorhexidine solution should be available to all birth attendants. Chlorhexidine is available in bulk bottles in differing concentrations (e.g. 5%).
- Concentrated chlorhexidine can be diluted to the appropriate concentration (0.2%–1%) in any setting, including under-resourced settings, using clean (boiled/sterilized) measuring containers and boiled drinking-quality (or sterilized) water.
- Pregnant women should be informed about the procedure during an antenatal health-care visit (if antenatal care is offered) and/or during labour by the birth attendant.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Procedures described above for the primary care level are also relevant for referral hospital setting.
AT HOME OR IN THE COMMUNITY
Procedures described above for the primary care level are also relevant for women who deliver at home or at community birthing facilities. However, if birth attendants at this level are unskilled, they would need to trained and informed appropriately.
- Mullany LC, Darmstadt GL, Tielsch JM. Safety and Impact of chlorhexidine antisepsis interventions for improving neonatal health in developing countries. Pediatr Infect Dis J 2006;25:665-75. Medline
- Wilson CM, Gray G, Read J, Mwatha A, Lala S, Johnson S, et al. Tolerance and safety of different concentrations of chlorhexidine for peripartum vaginal and infant washes: HIVNET 025. J Acquir Immune Defic Syndr 2004;35:138-43. Medline
This document should be cited as: Cutland CL. Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV): RHL practical aspects (last revised: 29 August 2007. The WHO Reproductive Health Library; Geneva: World Health Organization.