Intravaginal Metronidazole for the Prevention of Post-Cesarean Endometritis

Background:Postpartum endometritis is an important cause of maternal morbidity after cesarean section. Prophylactic antibiotic therapy reduces the risk by approximately 60%. The purpose of this study was to estimate the efficacy of preoperative administration of intra-vaginal Metronidazole for the prevention of post-cesarean endometritis. Methods: This double-blind, case-control, randomized trial included 292 patients whowere going to undergo elective cesarean deliveries. Patients were randomly selected to receive either 5 g of Metronidazole gel intra-vaginally (n = 146) or matching placebo (n = 146) before the initiation of the cesarean. Patients with chorioamnionitis, suspected allergy to Metronidazole, and/or PROM were excluded. Patients did not receive any other prophylactic antibiotic. The outcome variables included presence of febrile morbidity, endometritis, and wound infection. Data was analyzed by SPSS software (version 11.5) and P-value < 0.05 considered statistically significant.  Findings:Febrile disorder and endometritis were found in 5 (3.4%) patients who had received Metronidazole gel and 16 (11%) who had received placebo gel (P = 0.001). 11 (7.5%) patients receiving Metronidazole gel and 19 (13%) ones receiving placebo gel encountered wound infection (P = 0.001).  Conclusion:The preoperative administration of intra-vaginal Metronidazole gel appears to reduce the incidence of post-cesarean endometritis. Key Words:Metronidazole Gel, Post-Cesarean Endometritis, Prevention.