Chlorhexidine-Alcohol Compared with Povidone-Iodine Preoperative Skin Antisepsis for Cesarean Delivery: A Systematic Review and Meta-Analysis

Am J Perinatol. 2019 Jan;36(2):118-123. doi: 10.1055/s-0038-1669907. Epub 2018 Sep 5.


Objective: To compare chlorhexidine-alcohol with povidone-iodine solutions for skin antisepsis prior to cesarean delivery for the prevention of surgical site infection.

Study design: Electronic databases MEDLINE, Embase, Scopus, and were searched from inception to August 2017. Eligible studies included randomized controlled trials comparing chlorhexidine-alcohol with povidone-iodine skin preparation solutions for women undergoing cesarean delivery. The primary outcome was surgical site infection including superficial or deep wound infection. Meta-analysis was performed, and risk ratios (RRs) with 95% confidence interval (CI) were calculated using the Mantel-Haenszel random effects model. Statistical heterogeneity was assessed using Higgin's I 2.

Results: Of 61 abstracts identified in the primary search, four studies (3,059 women) met the eligibility criteria. The risk of surgical site infection was significantly reduced with chlorhexidine-alcohol (RR: 0.72; 95% CI: 0.52-0.98). No heterogeneity across studies was observed with I 2 = 0%. Subgroup analysis of superficial infection only or deep infection only showed no statistically significant difference (RR: 0.76, 95% CI: 0.54-1.08; and RR: 0.50, 95% CI: 0.23-1.10, respectively).

Conclusion: Preoperative skin cleansing prior to cesarean delivery with chlorhexidine-alcohol reduces surgical site infection as compared with povidone-iodine solutions.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Administration, Cutaneous
  • Anti-Infective Agents, Local / administration & dosage*
  • Antisepsis / methods*
  • Cesarean Section* / adverse effects
  • Chlorhexidine / administration & dosage*
  • Drug Combinations
  • Ethanol / administration & dosage*
  • Female
  • Humans
  • Povidone-Iodine / administration & dosage*
  • Pregnancy
  • Preoperative Care / methods
  • Surgical Wound Infection / prevention & control*


  • Anti-Infective Agents, Local
  • Drug Combinations
  • Ethanol
  • Povidone-Iodine
  • Chlorhexidine