{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:41:09Z","timestamp":1792384869146,"version":"4.4.0"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004697","name":"Hamadan University of Medical Sciences","doi-asserted-by":"publisher","award":["140409258995"],"award-info":[{"award-number":["140409258995"]}],"id":[{"id":"10.13039\/501100004697","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Despite routine prophylactic antibiotics, post\u2010cesarean infectious morbidity remains a major challenge. Preoperative vaginal preparation can reduce vaginal microbial load, but direct comparisons are scarce. This study compared metronidazole gel versus povidone\u2010iodine for preventing post\u2010cesarean infection\u2011related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This three\u2011arm randomized controlled trial was conducted at Fatemieh Hospital, Hamadan, Iran, from December 2025 to May 2026. A total of 201 women scheduled for elective cesarean delivery were randomized to metronidazole gel 0.75%, povidone\u2010iodine 10%, and control (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200967 each). Primary outcomes were endometritis, postoperative fever, and surgical site infection (SSI). Secondary outcomes included need for additional antibiotics, length of hospital stay, readmission, and adverse events. Data were analyzed in Stata v.17 using ANOVA and chi\u2010square tests (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The composite infectious morbidity was significantly lower in the metronidazole group (6\/67, 8.96%) compared to controls (21\/67, 31.34%) (risk difference: 22.4%; 95% CI: 9.5%\u201335.3%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Endometritis rates were 1\/67 (1.49%), 3\/67 (4.48%), and 8\/67 (11.94%) in the metronidazole, povidone\u2010iodine, and control groups, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). Fever rates were 2\/67 (2.99%), 5\/67 (7.46%), and 10\/67 (14.93%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Need for additional antibiotics was lower in the metronidazole group (7\/67, 10.45%) versus controls (18\/67, 26.87%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Only the composite outcome remained significant after Bonferroni correction; individual outcomes did not. No significant differences were observed for SSI, readmission, or length of stay.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Metronidazole gel significantly reduced composite infectious morbidity compared with no vaginal preparation, an effect that remained significant after adjustment for multiple comparisons. While individual outcomes showed clinically meaningful reductions, statistical significance was not maintained after Bonferroni correction. Metronidazole gel may be a promising option for vaginal preparation, particularly in high\u2010risk settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>IRCT20251227068466N1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73395","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:47:11Z","timestamp":1791982031000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Metronidazole Gel and Povidone\u2011Iodine for Vaginal Preparation in Preventing Post\u2011Cesarean Infection\u2011Related Morbidity: A Three\u2011Group Randomized Controlled Trial"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7677-1981","authenticated-orcid":false,"given":"Fatemeh","family":"Davodabadi","sequence":"first","affiliation":[{"name":"Student Research Committee, School of Allied Medical Sciences Hamadan University of Medical Sciences Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4402-914X","authenticated-orcid":false,"given":"Hamideh","family":"Parsapour","sequence":"additional","affiliation":[{"name":"Assistant Professor of Perinatology, Clinical Research Development Unit of Fatemieh Hospital, Department of Obstetrics and Gynecology, School of Medicine Hamadan University of Medical Sciences Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1544-8196","authenticated-orcid":false,"given":"Behzad","family":"Imani","sequence":"additional","affiliation":[{"name":"Department of Operating Room, School of Allied Medical Sciences Hamadan University of Medical Sciences Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Khazaei","sequence":"additional","affiliation":[{"name":"Research Center for Health Sciences Hamadan University of Medical Sciences Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8341-6073","authenticated-orcid":false,"given":"Mahnaz Moghadari","family":"Koosha","sequence":"additional","affiliation":[{"name":"Department of Operating Room, School of Allied Medical Sciences Hamadan University of Medical Sciences Hamadan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Caesarean Section Rates Continue to Rise, Amid Growing Inequalities In Access","year":"2021"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.4236\/ojim.2023.134030"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.21608\/ebwhj.2022.140071.1177"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007482.pub3"},{"issue":"2","key":"e_1_2_13_6_1","first-page":"69","article-title":"Infectious Morbidity After Cesarean Delivery: 10 Strategies to Reduce Risk","volume":"5","author":"Conroy K.","year":"2012","journal-title":"Reviews in Obstetrics & Gynecology"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.11.1300"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.18203\/2320-1770.ijrcog20212667"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007892.pub7"},{"key":"e_1_2_13_10_1","volume-title":"WHO Recommendation on Vaginal Preparation With Antiseptic Agents For Women Undergoing Caesarean Section","author":"World Health Organization","year":"2021"},{"key":"e_1_2_13_11_1","volume-title":"Metronidazole. 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Bacterial vaginosis \u2013 2021 STI treatment guidelines. 2021 accessed July 1 2026 https:\/\/www.cdc.gov\/std\/treatment-guidelines\/bv.htm."},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines13061505"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2025.09.046"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081123"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.38029\/babcockuniv.med.j.v7i2.506"},{"key":"e_1_2_13_17_1","volume-title":"WHO Recommendation on Prophylactic Antibiotics For Women Undergoing Caesarean section","author":"World Health Organization","year":"2021"},{"key":"e_1_2_13_18_1","volume-title":"National Healthcare Safety Network (NHSN): Reproductive Tract Infection (REPR) Checklist","year":"2024"},{"key":"e_1_2_13_19_1","volume-title":"Postpartum Infection. 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