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Antibacterial chlorhexidine applied to the vagina during labour to prevent early-onset group B streptococcal infection in the newborn Updated

Ohlsson A, Shah VS, Stade BC
Published Online: 
14 December 2014

There is no evidence to show that washing the vagina with the antibacterial liquid chlorhexidine or using a chlorhexidine gel during labour reduces group B β-hemolytic streptococcal (GBS) infections in babies.

A woman's vagina normally contains numerous bacteria that generally do not pose any problems to her or her baby. However, occasionally a baby picks up an infection during birth. GBS infection can cause severe illness in babies and rarely a baby may die as a result of the infection. Washing the vagina with chlorhexidine, or applying chlorhexidine gel or cream, during labour was studied in this systematic review as a possible way of reducing infections. The review of four trials included women who were colonized vaginally or rectally with GBS and their 1125 preterm and term infants. It showed that although chlorhexidine may reduce the number of bacteria that pass from the mothers to the babies as the babies pass through the birth canal, or if they suck in (aspirate) contaminated amniotic fluid, the studies were not large enough to say whether chlorhexidine reduced GBS infections or not.

Vaginal disinfection with chlorhexidine did not result in a reduction of early-onset GBS illness in the newborns such as sepsis, pneumonia, meningitis, or deaths caused by the infection. It may reduce GBS colonization of newborns when compared with mechanical washing with placebo (from one study).

For the comparison chlorhexidine gel or cream versus placebo or no treatment, there were no significant results for the outcomes reported.

Maternal mild side effects such as stinging or local irritation were more common in women treated with chlorhexidine. Different preparations, doses, frequency of dose, and reported outcomes were used. No side effects were reported among the newborns.

The small number of studies that reported on each of the outcomes of interest; and the relatively small sample size (1125 infants), given the low incidence of GBS infection (one to three per 1000 live births) in the general population, meant that the evidence was limited.

There is a need to conduct a large, well-designed randomized trial that examines the efficacy of vaginal disinfection with chlorhexidine for reducing GBS infection in term and preterm infants and overcomes the methodological limitations of the included studies. Costs associated with treatment with antibiotics and lack of skilled personnel have limited the availability of preventative treatment for women in poorer areas of the world. Chlorhexidine is inexpensive and has no impact on development of antibiotic resistance.

This record should be cited as: 
Ohlsson A, Shah VS, Stade BC. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD003520. DOI: 10.1002/14651858.CD003520.pub3
Assessed as up to date: 
31 October 2014