{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T02:32:22Z","timestamp":1793241142187,"version":"4.5.0"},"reference-count":94,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["ajog.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Obstetrics and Gynecology"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1016\/j.ajog.2025.09.046","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T08:39:50Z","timestamp":1767343190000},"page":"S504.e1-S504.e41","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"special_numbering":"S","title":["Chlorhexidine is the preferred agent for vaginal antisepsis prior to cesarean delivery: a systematic review and network meta-analysis"],"prefix":"10.1016","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9485-1521","authenticated-orcid":false,"given":"Jordan A.","family":"McKinney","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1449-0130","authenticated-orcid":false,"given":"Luis","family":"Sanchez-Ramos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Duncan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifeng","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Rhoades","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Mateus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Dussan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldine","family":"Nino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Messiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Pomputius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajog.2025.09.046_bib1","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.1274","article-title":"Global increased cesarean section rates and public health implications: a call to action","volume":"6","author":"Angolile","year":"2023","journal-title":"Health Sci Rep"},{"key":"10.1016\/j.ajog.2025.09.046_bib2","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1016\/S2214-109X(15)70094-X","article-title":"Use of the robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys","volume":"3","author":"Vogel","year":"2015","journal-title":"Lancet Global Health"},{"key":"10.1016\/j.ajog.2025.09.046_bib3","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.42215","article-title":"Low-value surgical procedures in low-and middle-income countries: a systematic scoping review","volume":"6","author":"Albarqouni","year":"2023","journal-title":"JAMA Network Open"},{"key":"10.1016\/j.ajog.2025.09.046_bib4","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/birt.12104","article-title":"Searching for the optimal rate of medically necessary cesarean delivery","volume":"41","author":"Ye","year":"2014","journal-title":"Birth"},{"key":"10.1016\/j.ajog.2025.09.046_bib5","series-title":"Births: provisional data for 2023. Hyattsville, MD: National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention;","author":"Hamilton","year":"2024"},{"key":"10.1016\/j.ajog.2025.09.046_bib6","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.18203\/2320-1770.ijrcog20150729","article-title":"Analytical study of indications of cesarean section","volume":"4","author":"Pandya","year":"2015","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib7","doi-asserted-by":"crossref","first-page":"178S","DOI":"10.1097\/00006250-198003001-00045","article-title":"Clinical risk factors for puerperal infection","volume":"55","author":"GIBBS","year":"1980","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib8","first-page":"CD007482","article-title":"Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section","volume":"2014","author":"Smaill","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2025.09.046_bib9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001672","article-title":"Severe maternal sepsis in the UK, 2011-2012: a national case-control study","volume":"11","author":"Acosta","year":"2014","journal-title":"PLoS Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib10","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/QCO.0b013e328339257c","article-title":"Maternal sepsis: epidemiology, etiology and outcome","volume":"23","author":"van Dillen","year":"2010","journal-title":"Curr Opin Infect Dis"},{"key":"10.1016\/j.ajog.2025.09.046_bib11","first-page":"69","article-title":"Infectious morbidity after cesarean delivery: 10 strategies to reduce risk","volume":"5","author":"Conroy","year":"2012","journal-title":"Rev Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib12","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/01.AOG.0000139774.02618.ba","article-title":"Maternal morbidity associated with vaginal versus cesarean delivery","volume":"104","author":"Burrows","year":"2004","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib13","first-page":"5","article-title":"Rates of infection related to cesarean and vaginal delivery at HCPA","volume":"32","author":"Benincasa","year":"2012","journal-title":"Revista HCPA Porto Alegre"},{"key":"10.1016\/j.ajog.2025.09.046_bib14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40748-017-0051-3","article-title":"Surgical site infections after cesarean delivery: epidemiology, prevention and treatment","volume":"3","author":"Kawakita","year":"2017","journal-title":"Matern Health Neonatol Perinatol"},{"key":"10.1016\/j.ajog.2025.09.046_bib15","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/01.aoa.0000386842.81244.28","article-title":"Risk of selected postpartum infections after cesarean section compared with vaginal birth: a 5-year cohort study of 32,468 women","volume":"30","author":"Leth","year":"2010","journal-title":"Obstet Anesthesia Digest"},{"issue":"Suppl 1","key":"10.1016\/j.ajog.2025.09.046_bib16","first-page":"1","article-title":"Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom","volume":"118","author":"Cantwell","year":"2011","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2025.09.046_bib17","first-page":"330","article-title":"Evaluation of puerperal and postpartum infections after cesarean section and their clinical outcomes","volume":"13","author":"Feruza","year":"2023","journal-title":"Open J Intern Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-017-1479-1","article-title":"Institutional maternal and perinatal deaths: a review of 40 low and middle income countries","volume":"17","author":"Bailey","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"10.1016\/j.ajog.2025.09.046_bib19","doi-asserted-by":"crossref","first-page":"e1002","DOI":"10.1097\/CCM.0000000000003355","article-title":"Pregnancy-related ICU admissions from 2008 to 2016 in China: a first multicenter report","volume":"46","author":"Zhao","year":"2018","journal-title":"Crit Care Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib20","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1097\/01.AOG.0000233154.62729.24","article-title":"Postpartum maternal mortality and cesarean delivery","volume":"108","author":"Deneux-Tharaux","year":"2006","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/bmb\/ldg015","article-title":"Global burden of maternal death and disability","volume":"67","author":"AbouZahr","year":"2003","journal-title":"Br Med Bull"},{"key":"10.1016\/j.ajog.2025.09.046_bib22","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1097\/AOG.0000000000002833","article-title":"ACOG practice bulletin no. 199: use of prophylactic antibiotics in labor and delivery","volume":"132","year":"2018","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib23","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.ajog.2017.09.017","article-title":"Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis","volume":"218","author":"Yu","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib24","doi-asserted-by":"crossref","first-page":"451.e1","DOI":"10.1016\/j.ajog.2018.02.011","article-title":"Comparison of staples vs subcuticular suture in class III obese women undergoing cesarean: a randomized controlled trial","volume":"218","author":"Zaki","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib25","doi-asserted-by":"crossref","first-page":"463.e1","DOI":"10.1016\/j.ajog.2017.05.060","article-title":"A randomized open-label controlled trial of chlorhexidine-alcohol vs povidone-iodine for cesarean antisepsis: the CAPICA trial","volume":"217","author":"Springel","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib26","doi-asserted-by":"crossref","first-page":"406.e1","DOI":"10.1016\/j.ajog.2017.01.009","article-title":"Skin closure at cesarean delivery, glue vs subcuticular sutures: a randomized controlled trial","volume":"216","author":"Daykan","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib27","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/AOG.0000000000002167","article-title":"Vaginal cleansing before cesarean delivery: a systematic review and meta-analysis","volume":"130","author":"Caissutti","year":"2017","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib28","article-title":"Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections","volume":"4","author":"Haas","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2025.09.046_bib29","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajogmf.2023.100990","article-title":"Different methods of vaginal preparation before cesarean delivery to prevent postoperative infection: a systematic review and network meta-analysis","volume":"5","author":"Liu","year":"2023","journal-title":"Am J Obstet Gynecol MFM"},{"key":"10.1016\/j.ajog.2025.09.046_bib30","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1097\/01.AOG.0000433982.36184.95","article-title":"Committee opinion no. 571: solutions for surgical preparation of the vagina","volume":"122","year":"2013","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib31","doi-asserted-by":"crossref","first-page":"2659","DOI":"10.1111\/jog.15377","article-title":"Vaginal preparation with different antiseptic solutions before cesarean section for preventing postoperative infections: a systematic review and network meta-analysis","volume":"48","author":"Fadlalmola","year":"2022","journal-title":"J Obstet Gynaecol Res"},{"key":"10.1016\/j.ajog.2025.09.046_bib32","doi-asserted-by":"crossref","first-page":"86","DOI":"10.38029\/babcockuniv.med.j..v7i2.506","article-title":"The effect of preoperative vaginal preparation with povidone-iodine on post-caesarean section infection","volume":"7","author":"Agbana","year":"2024","journal-title":"Babcock University Med J"},{"key":"10.1016\/j.ajog.2025.09.046_bib33","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1055\/a-2217-8556","article-title":"Preoperative application of chlorhexidine to reduce infection with cesarean delivery after labor (PRACTICAL): a randomized clinical trial","volume":"41","author":"DeBolt","year":"2024","journal-title":"Am J Perinatol"},{"key":"10.1016\/j.ajog.2025.09.046_bib34","first-page":"20","article-title":"Vaginal preparation with chlorhexidine before cesarean section and the rate of endometritis and post-operative wound infection","volume":"26","author":"Elmizadeh","year":"2024","journal-title":"Iran J Obstet Gynecol Infertil"},{"key":"10.1016\/j.ajog.2025.09.046_bib35","first-page":"1195","article-title":"A case study on to compare efficacy of povidone iodine Vs normal saline in prevention of postpartum endometritis and related febrile morbidity in women going under elective lscs","volume":"13","author":"Geetha","year":"2024","journal-title":"Front Health Inform"},{"key":"10.1016\/j.ajog.2025.09.046_bib36","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.medcle.2016.10.003","article-title":"The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA","volume":"147","author":"Hutton","year":"2016","journal-title":"Med Cl\u00edn (English Edition)"},{"key":"10.1016\/j.ajog.2025.09.046_bib37","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1186\/s12911-019-0992-8","article-title":"Improving reference prioritisation with PICO recognition","volume":"19","author":"Brockmeier","year":"2019","journal-title":"BMC Med Inform Decis Mak"},{"key":"10.1016\/j.ajog.2025.09.046_bib38","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s41073-023-00130-8","article-title":"Checklist to assess trustworthiness in RAndomised controlled trials (TRACT checklist): concept proposal and pilot","volume":"8","author":"Mol","year":"2023","journal-title":"Res Integr Peer Rev"},{"key":"10.1016\/j.ajog.2025.09.046_bib39","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12916-024-03322-1","article-title":"Low awareness of the transitivity assumption in complex networks of interventions: a systematic survey from 721 network meta-analyses","volume":"22","author":"Spineli","year":"2024","journal-title":"BMC Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib40","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/jrsm.1044","article-title":"Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies","volume":"3","author":"Higgins","year":"2012","journal-title":"Res Synth Methods"},{"key":"10.1016\/j.ajog.2025.09.046_bib41","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/0272989X12458724","article-title":"Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials","volume":"33","author":"Dias","year":"2013","journal-title":"Med Decis Mak"},{"key":"10.1016\/j.ajog.2025.09.046_bib42","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1002\/sim.6381","article-title":"Predictive distributions for between-study heterogeneity and simple methods for their application in bayesian meta-analysis","volume":"34","author":"Turner","year":"2015","journal-title":"Stat Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib43","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.9735","article-title":"Use of prediction intervals in network meta-analysis","volume":"2","author":"Lin","year":"2019","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.ajog.2025.09.046_bib44","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jclinepi.2010.03.016","article-title":"Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial","volume":"64","author":"Salanti","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.ajog.2025.09.046_bib45","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1177\/096228020101000404","article-title":"Bayesian methods in meta-analysis and evidence synthesis","volume":"10","author":"Sutton","year":"2001","journal-title":"Stat Methods Med Res"},{"key":"10.1016\/j.ajog.2025.09.046_bib46","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"10.1016\/j.ajog.2025.09.046_bib47","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g5630","article-title":"A GRADE working group approach for rating the quality of treatment effect estimates from network meta-analysis","volume":"349","author":"Puhan","year":"2014","journal-title":"BMJ"},{"key":"10.1016\/j.ajog.2025.09.046_bib48","doi-asserted-by":"crossref","first-page":"12","DOI":"10.54079\/jpmi.37.1.3114","article-title":"Vaginal cleansing before emergency cesarean section and post-operative infectious morbidity; clinical trial in a low resource setting","volume":"37","author":"Abrar","year":"2023","journal-title":"J Postgrad Med Inst"},{"key":"10.1016\/j.ajog.2025.09.046_bib49","first-page":"369","article-title":"Pre-caesarean section vaginal preparation with chlorhexidine solution in preventing puerperal infectious morbidities: a randomized controlled trial","volume":"39","author":"Adeyemo","year":"2022","journal-title":"W Afr J Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib50","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1080\/14767058.2016.1219996","article-title":"Chlorhexidine vaginal wipes prior to elective cesarean section: does it reduce infectious morbidity? A randomized trial","volume":"30","author":"Ahmed","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib51","doi-asserted-by":"crossref","first-page":"864","DOI":"10.21608\/ejhc.2022.222511","article-title":"Effect of pre-elective cesarean section vaginal cleansing using povidone-iodine versus chlorhexidine on the incidence of post-cesarean infections","volume":"13","author":"Ahmed","year":"2022","journal-title":"Egy J Health Care"},{"key":"10.1016\/j.ajog.2025.09.046_bib52","first-page":"260","article-title":"Influence of pre-operative vaginal cleansing with povidone iodine on postcesarean infection","volume":"11","author":"Alobaidy","year":"2020","journal-title":"J Cardiovasc Dis Res"},{"key":"10.1016\/j.ajog.2025.09.046_bib53","doi-asserted-by":"crossref","DOI":"10.1016\/j.jogoh.2020.101981","article-title":"The effect of vaginal disinfection on reducing post-caesarean endometritis: a prospective, randomised controlled trial","volume":"50","author":"Ba\u011fl\u0131","year":"2021","journal-title":"J Gynecol Obstet Hum Reprod"},{"key":"10.1016\/j.ajog.2025.09.046_bib54","first-page":"1","article-title":"Impact of preoperative vaginal preparation with povidone iodine on post cesarean infection","volume":"2","author":"Barat","year":"2016","journal-title":"Caspian J Reprod Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib55","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.18203\/2320-1770.ijrcog20212667","article-title":"Vaginal preparation with povidone iodine solution before caesarean section and its impact on the post-operative infectious morbidity","volume":"10","author":"Chandra","year":"2021","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib56","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajogmf.2020.100114","article-title":"A randomized trial of the bactericidal effects of chlorhexidine vs povidone-iodine vaginal preparation","volume":"2","author":"Duffy","year":"2020","journal-title":"Am J Obstet Gynecol MFM"},{"key":"10.1016\/j.ajog.2025.09.046_bib57","first-page":"886","article-title":"A study on reducing postoperative incision infection through vaginal povidone-iodine disinfection in emergency cesarean section with full cervical dilation","volume":"33","author":"Fu","year":"2022","journal-title":"Modern Diagnosis Treat"},{"key":"10.1016\/j.ajog.2025.09.046_bib58","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/S1068-607X(02)00119-1","article-title":"Post-cesarean related infection and vaginal preparation with povidone-iodine revisited","volume":"9","author":"Guzman","year":"2002","journal-title":"Primary Care Update OB\/GYNS"},{"key":"10.1016\/j.ajog.2025.09.046_bib59","doi-asserted-by":"crossref","first-page":"310.e1","DOI":"10.1016\/j.ajog.2010.01.005","article-title":"Vaginal cleansing before cesarean delivery to reduce postoperative infectious morbidity: a randomized, controlled trial","volume":"202","author":"Haas","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib60","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1111\/aogs.13737","article-title":"Vaginal preparation with chlorhexidine at cesarean section to reduce endometritis and prevent sepsis: a randomized pilot trial (PREPS)","volume":"99","author":"Hodgetts-Morton","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2025.09.046_bib61","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5472\/marumj.866504","article-title":"The effect of vaginal cleansing performed with normal saline solution or povidone-iodine before elective caesarean section on postoperative maternal morbidity and infection; A prospective randomized controlled study","volume":"34","author":"Kanza","year":"2021","journal-title":"Marmara Medical Journal"},{"key":"10.1016\/j.ajog.2025.09.046_bib62","series-title":"Effect of preoperative vaginal cleansing with povidone iodine on post-caesarean maternal infections at Kenyatta National Hospital; a randomized controlled trial","author":"Karanja","year":"2017"},{"key":"10.1016\/j.ajog.2025.09.046_bib63","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.18203\/2320-1770.ijrcog20202329","article-title":"Efficacy of betadine vaginal toileting before caesarean section in postoperative infections","volume":"9","author":"Kaur","year":"2020","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib64","first-page":"142","article-title":"Effect of prophylactic preoperative nursing interventions on prevention of endometritis among women undergoing elective caesarean delivery","volume":"6","author":"Khedr","year":"2016","journal-title":"J Nurs Educ Pract"},{"key":"10.1016\/j.ajog.2025.09.046_bib65","first-page":"95","article-title":"Vaginal cleansing prior to cesarean section and post-operative infectious morbidity","volume":"8","author":"Kiani","year":"2018","journal-title":"J Soc Obstet Gynaecol Pakistan"},{"key":"10.1016\/j.ajog.2025.09.046_bib66","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.ajogmf.2019.03.004","article-title":"Vaginal cleansing with chlorhexidine gluconate or povidone-iodine prior to cesarean delivery: a randomized comparator-controlled trial","volume":"1","author":"Lakhi","year":"2019","journal-title":"Am J Obstet Gynecol MFM"},{"key":"10.1016\/j.ajog.2025.09.046_bib67","first-page":"321","article-title":"Vaginal preparation with povidone-iodine solution before cesarean section forPreventing postpartum endometritis: a randomized clinical trial","volume":"29","author":"LI","year":"2013","journal-title":"J Prac Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib68","doi-asserted-by":"crossref","first-page":"107","DOI":"10.5430\/cns.v7n1p107","article-title":"Effect of preoperative vaginal cleansing using chlorhexidine antiseptic on post cesarean section infectious morbidity","volume":"7","author":"Marzouk","year":"2019","journal-title":"Clin Nurs Stud"},{"key":"10.1016\/j.ajog.2025.09.046_bib69","first-page":"2118","article-title":"Preoperative vaginal preparation with chlorhexidine gluconate to reduce post cesarean delivery infectious morbidity","volume":"4","author":"Megahed","year":"2022","journal-title":"Egypt: IJMA"},{"key":"10.1016\/j.ajog.2025.09.046_bib70","first-page":"1179","article-title":"Effect of preoperative vaginal cleansing with an antiseptic solution to reduce post caesarean infectious morbidity","volume":"61","author":"Memon","year":"2011","journal-title":"J Pak Med Assoc"},{"key":"10.1016\/j.ajog.2025.09.046_bib71","first-page":"75","article-title":"Vaginal preparation with antiseptic solution before cesarean section for reducing post partum morbidity","volume":"4","author":"Mohamed","year":"2015","journal-title":"OSR-JNHS"},{"key":"10.1016\/j.ajog.2025.09.046_bib72","first-page":"4310","article-title":"Antiseptic vaginal preparation before cesarean delivery to reduce post operative infection: a randomised controlled trial","volume":"3","author":"Nandi","year":"2015","journal-title":"J Med Sci Clin Res"},{"key":"10.1016\/j.ajog.2025.09.046_bib73","doi-asserted-by":"crossref","first-page":"14","DOI":"10.33545\/gynae.2022.v6.i2a.1157","article-title":"Effectiveness of inclusion of chlorhexidine cleansing in pre-operative preparation of C-Section in reducing postpartum endometritis: a comparative study in tertiary care institute","volume":"6","author":"Nihar","year":"2022","journal-title":"Int J Clin Obstet Gynaecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib74","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1177\/00494755221130561","article-title":"Effectiveness of chlorhexidine vaginal cleansing in reducing post-caesarean endometritis at two tertiary hospitals in Enugu, Nigeria: a randomized controlled trial","volume":"53","author":"Nnagbo","year":"2023","journal-title":"Trop Doct"},{"key":"10.1016\/j.ajog.2025.09.046_bib75","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1111\/aogs.14060","article-title":"Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: a randomized controlled trial","volume":"100","author":"Ogah","year":"2021","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2025.09.046_bib76","first-page":"81","article-title":"Does vaginal preparation with povidone-iodine prior to cesarean delivery reduce the risk of endometritis?","volume":"5","author":"\u00d6lmez","year":"2013","journal-title":"Comprehensive Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib77","first-page":"745","article-title":"Adjunctive intravaginal metronidazole for the prevention of postcesarean endometritis: a randomized controlled trial","volume":"98","author":"Pitt","year":"2001","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib78","first-page":"1147","article-title":"Vaginal preparation with povidone-iodine and postcesarean infection morbidity: a randomized controlled trial","volume":"97","author":"Reid","year":"2001","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib79","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/S0002-9378(97)70557-X","article-title":"Chlorhexidine vaginal irrigation for the prevention of peripartal infection: a placebo-controlled randomized clinical trial","volume":"176","author":"Rouse","year":"1997","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib80","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1067\/mob.2003.322","article-title":"Clinical trial of chlorhexidine vaginal irrigation to prevent peripartal infection in nulliparous women","volume":"189","author":"Rouse","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib81","first-page":"449","article-title":"Effect of clindamycin vaginal pessary before cesarean section on postpartum infectious morbidity","volume":"3","author":"Salem","year":"2022","journal-title":"Microb Infect Dis"},{"key":"10.1016\/j.ajog.2025.09.046_bib82","article-title":"Comparative study of preoperative vaginal preparation with cetrimide versus routine care for evaluating postpartum uterine sepsis","volume":"15","author":"Salvi","year":"2023","journal-title":"Pravara Med Rev"},{"key":"10.1016\/j.ajog.2025.09.046_bib83","first-page":"30","article-title":"Intravaginal metronidazole for the prevention of post-cesarean endometritis","volume":"27","author":"Sekhavat","year":"2009","journal-title":"J Isfahan Med School"},{"key":"10.1016\/j.ajog.2025.09.046_bib84","doi-asserted-by":"crossref","first-page":"26","DOI":"10.59204\/2314-6788.1077","article-title":"Prevention of endometritis by precesarean section vaginal preparation using povidone\u2013iodine versus chlorhexidine","volume":"36","author":"Shahin","year":"2023","journal-title":"Menoufia Med J"},{"key":"10.1016\/j.ajog.2025.09.046_bib85","first-page":"4895","article-title":"Study on the preventive effect of preoperative vaginal disinfection with povidone-iodine on postpartum endometritis and abdominal incision infection in cesarean section","volume":"29","author":"Shang","year":"2014","journal-title":"China Materna Child Health"},{"key":"10.1016\/j.ajog.2025.09.046_bib86","doi-asserted-by":"crossref","first-page":"630","DOI":"10.21608\/ejhc.2021.167097","article-title":"Effect of vaginal cleansing with povidone iodine solution before cesarean section on postoperative endometritis infection","volume":"12","author":"Soliman Ahmed","year":"2021","journal-title":"Egypt J Health Care"},{"key":"10.1016\/j.ajog.2025.09.046_bib87","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1097\/01.AOG.0000164032.16599.7e","article-title":"Preoperative vaginal preparation with povidone-iodine and the risk of postcesarean endometritis","volume":"105","author":"Starr","year":"2005","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib88","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S0002-9378(97)70510-6","article-title":"Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection","volume":"176","author":"Sweeten","year":"1997","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib89","doi-asserted-by":"crossref","first-page":"739.e1","DOI":"10.1016\/j.ajog.2022.11.1300","article-title":"Vaginal cleansing before unscheduled cesarean delivery to reduce infection: a randomized clinical trial","volume":"228","author":"Temming","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2025.09.046_bib90","first-page":"486","article-title":"Preoperative vaginal preparation using povidone iodine versus chlorhexidine solutions in prevention of endometritis in elective cesarean section","volume":"4","author":"Tewfik","year":"2015","journal-title":"Int J Curr Microbiol App Sci"},{"key":"10.1016\/j.ajog.2025.09.046_bib91","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajogmf.2022.100572","article-title":"Preoperative vaginal cleansing with chlorhexidine vs placebo in patients with rupture of membranes: a prospective, randomized, double-blind, placebo-control study","volume":"4","author":"Urena","year":"2022","journal-title":"Am J Obstet Gynecol MFM"},{"key":"10.1016\/j.ajog.2025.09.046_bib92","doi-asserted-by":"crossref","first-page":"2316","DOI":"10.3109\/14767058.2012.693994","article-title":"Does vaginal preparation with povidone-iodine prior to caesarean delivery reduce the risk of endometritis? A randomized controlled trial","volume":"25","author":"Yildirim","year":"2012","journal-title":"J Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2025.09.046_bib93","first-page":"117","article-title":"Preoperative vaginal painting with 1% povidone-iodine before cesarean delivery to reduce postoperative febrile morbidity: a randomized control trial","volume":"30","author":"Charoenviboonphan","year":"2011","journal-title":"Region 4-5 Med J"},{"key":"10.1016\/j.ajog.2025.09.046_bib94","doi-asserted-by":"crossref","first-page":"261.e1","DOI":"10.1016\/j.ajog.2019.04.002","article-title":"Povidone-iodine 1% is the most effective vaginal antiseptic for preventing post-cesarean endometritis: a systematic review and network meta-analysis","volume":"221","author":"Roeckner","year":"2019","journal-title":"Am J Obstet Gynecol"}],"container-title":["American Journal of Obstetrics and Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937825007197?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937825007197?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:57:32Z","timestamp":1793239052000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0002937825007197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":94,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["S0002937825007197"],"URL":"https:\/\/doi.org\/10.1016\/j.ajog.2025.09.046","relation":{},"ISSN":["0002-9378"],"issn-type":[{"value":"0002-9378","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Chlorhexidine is the preferred agent for vaginal antisepsis prior to cesarean delivery: a systematic review and network meta-analysis","name":"articletitle","label":"Article Title"},{"value":"American Journal of Obstetrics and Gynecology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajog.2025.09.046","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}